What are the procedures of splinting in the treatment of mallet finger?

Updated: Aug 27, 2018
  • Author: Roy A Meals, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

Various means are available for holding the DIP joint in extension. Splinting can be isolated to the distal joint if the proximal interphalangeal (PIP) joint is not lax and does not hyperextend. Splinting the PIP joint in partial flexion for the first half of treatment is appropriate if the untreated finger assumes a swan-neck posture.

Small strips of aluminum with foam-rubber backing are commonly used in splinting. The foam backing should be of the closed-pore variety so that the foam does not absorb moisture. The open-pore form retains water in its interstices and harbors various microorganisms that hamper proper hygiene. Closed-pore foam aluminum strips are available from various orthopedic supply houses.

The aluminum strip can be applied either dorsally or volarly. Applied dorsally, the aluminum strip requires two strips of tape—one around the midportion of the middle phalanx and one around the midportion of the distal phalanx—for the splint to achieve three-point fixation and maintain the distal joint in an extended position. Dorsal splinting allows the digital pulp to be partially exposed for keyboarding and other daily activities. In addition, dorsal splints are more effective at maintaining the joint in full extension. (See the image below.)

Dorsal aluminum foam splint for the treatment of a Dorsal aluminum foam splint for the treatment of a mallet finger.

Volar splinting, however, requires only one band of tape around the finger, at the level of the distal joint, to achieve three-point fixation; thus, the volar splint is slightly easier to apply and maintain. The aluminum strip, however, precludes any tactile feedback from the digital pulp for light activities.

Other rigid materials can be used for makeshift splints. A large paper clip can be padded with adhesive tape and then used as a splint. Also, some patients have improvised temporary splints with plastic disposable spoons or sections of wooden ice-cream sticks.

Premolded plastic splints are available commercially. However, they often do not fit the finger closely enough to maintain the joint in full extension. These splints have the added disadvantages of entirely covering and blinding the pulp from tactile sensation and preventing evaporation of moisture from the enclosed skin.

Having witnessed the shortcomings of the various splints, as noted above, the author devised a simple, custom-molded plastic splint, as shown in the images below. This splint leaves the pulp relatively exposed for functional activities, adheres closely to the contour of the digit without the need for tape, and is of sufficiently low profile to allow for evaporation of moisture from between the splint and the skin. Blanks can be made from various thermoplastic materials that are routinely used by hand therapists or can be purchased commercially. [10]

 

This photo demonstrates a thermoplastic blank for This photo demonstrates a thermoplastic blank for a custom-molded mallet finger splint and an oblique view of the molded splint in place.

 

Dorsal view of the custom-molded thermoplastic spl Dorsal view of the custom-molded thermoplastic splint in place.

 

Volar view of the thermoplastic splint in place. Volar view of the thermoplastic splint in place.

 

Application of the thermoplastic splint.

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