AN OVERVIEW OF MALLET FINGER INJURIES

Main Article Content

Bhavika Khera
Chad Chang
Waseem Bhat

Keywords

Mallet, Finger, Fracture, Fingertip, Tendon

Abstract

Mallet finger describes a fingertip deformity where the distal interphalangeal joint (DIPJ) of the affected digit is held in flexion, unable to extend the distal phalanx actively. The deformity is typically a consequence of traumatic disruption to the terminal extensor tendon at its insertion at the proximal portion of the distal phalanx or slightly proximally at the level of the DIPJ.


Patients typically present with a history describing the event of injury with a typical mallet deformity. Common mechanisms include sport activities causing a direct blow to the finger, low energy trauma while performing simple tasks such as pulling up socks or crush injuries from getting the finger trapped in a door. The DIPJ can be passively extended, but this extension of the joint cannot be maintained once the passive extension is stopped.


The Doyle classification can be used to categorise and dictate treatment. The extensor lag associated with the deformity does not improve spontaneously without treatment. Inappropriate management can lead to chronic functional loss and stiffness of the finger.


The majority of closed mallet splints are Doyle type I, which can be managed non-surgically with external splints, worn full-time to keep the fingertip straight until the tendon injury or fracture heals. Surgical techniques is considered for other types of mallet injuries. Techniques used include closed reduction and Kirschner wire fixation, open reduction and internal fixation, reconstruction of the terminal extensor tendon and correction of swan neck deformity.

Downloads

Download data is not yet available.
Abstract 40 |

References

1. Ramponi DR, Hellier SD. Mallet Finger. Adv Emerg Nurs J. 2019; 41(3):198-203.
2. Lin JS, Samora JB. Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am. 2018 Feb;43(2):146-163.e2.
3. Kootstra TJM, Keizer J, van Heijl M, Ferree S, Houwert M, van der Velde D. Delayed Extension Block Pinning in 27 Patients With Mallet Fracture. Hand. 2019;1558944719840749
4. Lamaris G, Matthew M. The diagnosis and management of mallet finger injuries. Hand. 2019;12(3):223–28
5. Botero SS, Diaz JJ, Benaida A, Collon S, Facca S, Liverneaux PA. Review of acute traumatic closed mallet finger injuries in adults. Arch Plast Surg. 2016;43(2):134-144.
6. Handoll HHG, Vaghela MV. Interventions for treating mallet finger injuries. Cochrane Database Syst Rev. 2004;(3):CD004574
7. Doyle JR. Extensor tendons acute injuries. In: Green DP, editor. Operative hand surgery. 3rd ed. New York: Churchill Livingstone; 1993. pp. 1950–1987
8. Turner AP, Mabrouk A, Cooper JS. Mallet finger. StatPearls Publishing; Treasure Island (FL): 2020.
9. Wang T, Qi H, Teng J, Wang Z, Zhao B. The role of high frequency ultrasonography in diagnosis of acute closed mallet finger injury. Scientific Reports. 2017;7(1):11049
10. Valdes K, Naughton N, Algar L. ICF components of outcome measures for mallet finger: A systematic review. J Hand Ther. 2016;29(4):388-95
11. Shimura H, Wakabayashi Y, Nimura A. A novel closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation for mallet fractures. J Orthop Sci. 2014;19(2):308–12
12. Handoll HHG, Vaghela MV. Interventions for treating mallet finger injuries. Cochrane Database Syst Rev. 2004;(3):CD004574
13. Al-Nammari SS. Best Treatment for mallet finger. Bestbets. 2010
14. Vernet P, Igeta Y, Facca S, Toader H, Diaz JJH, Liverneaux P. Treatment of tendious mallet fingers using a Stack splint versus a dorsal glued splint. Eur J Orthop Surg Traumatol. 2019;29(3):591-596.
15. Kalainov DM, Hoepfner PE, Hartigan BJ, Carroll C, Genuario J. Nonsurgical treatment of closed mallet finger fractures. J Hand Surg Am. 2005;30(3):580-6.
16. Lin JS, Samora JB. Surgical and nonsurgical management of mallet finger a systematic review. J Hand Surg Am. 2018; 43(2):146-63
17. Alla SR, Deal ND, Dempsey IJ. Current concepts: mallet finger. Hand (NY). 2015;9(2):138-44.
18. Kardestuncer T, Bae DS, Waters PM. The results of tenodermodesis for severe chronic mallet finger deformity in children. J Pediatr Orthop. 2008;28(1):81–5.
19. Shin EK, Bae DS. Tenodermodesis for chronic mallet finger deformities in children. Tech HandUpper Extrem Surg. 2007;11(4):262–5.
20. Sorene ED, Goodwin DR. Tenodermodesis for established mallet finger deformity. Scand J Plast Reconstr Surg Hand Surg. 2004;38(1):43–5.
21. Bowers HW, Hurst LC. Chronic mallet finger: the use of Fowler’s central slip release. J Hand Surg. 1978;3:373–6.
22. Lucchina A, Badia A, Nistor A, Fusetti C. Surgical treatment options for unstable mallet fractures. Plast Reconstr Surg. 2011;128(2):599-600.
23. Advice after a ‘mallet finger’ injury. Fracture clinic patient information leaflet. Royal United Hospitals Bath NHS Foundation Trust. 2020. Pages 1-3. https://www.ruh.nhs.uk/patients/patient_information/ORT056_Advice_after_a_mallet_finger_injury.pdf (assessed 28/09/2020)