Mallet finger

 

Pathology

 

1.  Soft tissue

- extensor tendon rupture from distal phalax

- laceration / crush injury

 

 

2.  Bony fracture

 

 

Clinical

 

Drop finger / extension lag of the DIPJ

 

Mechanism

 

Axial load

- extensor tendon attached to bony fragment

 

Non operative management

 

Closed treatment

- mallet splint (Stack)

- expect 10^o extensor lag with mild loss ROM

- good results with non – op management

 

Operative Management

 

Indication

- volar subluxation of distal phalanx

- fragment > 50% joint surface

- chronic > 12 weeks old

 

Open treatment

- high incidence of complications

- percutaneous K wire recommended

 

Technique

1.  Reduce and axial K wire

2.  Dorsal blocking K wire / axial K wire

 

Wehbe and Schneider JBJS Am 1984

- 21 patients with intra-articular fractures

- 15 treated non operatively

- 6 treated operatively

- nil improvement in outcome

- worsened surgical morbidity