When is surgery indicated for mallet finger?

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

When a large bony fragment is observed, the surgeon instinctively wants to anatomically reconstruct the articular surface. It must be kept in mind, however, that this is a nonweightbearing joint, and articular incongruity, which would not be tolerated in the ankle or knee, is well tolerated in the DIP joint. This joint has been demonstrated to remodel beautifully over time, even in the presence of volar subluxation of the distal phalanx.

Moreover, late osteoarthritis at the DIP joint of an untreated mallet finger or a mallet finger that is treated without anatomic reduction of the fracture is rare, if not nonexistent. Thus, the risk of poor outcome from ill-advised open treatment far outweighs any risk of early dysfunction or late arthritis from splint treatment.

The appropriate indications for surgical fixation of mallet fractures, which techniques to use, and the accuracy of outcome measures are frequently debated. [11, 1, 12] Most authors agree that mallet fractures that are associated with volar subluxation of the distal phalanx should be referred to an orthopedic surgeon for fixation.

Referral should also be considered for cases in which there are large or displaced avulsion fragments that involve more than 30-40% of the joint surface. [11] Surgical fixation of a mallet fracture of the thumb is sometimes recommended because of the greater extrinsic displacing forces across the interphalangeal joint.


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