What is included in the initial treatment of mallet finger?

Updated: Jan 18, 2018
  • Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD  more...
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Answer

The mallet finger is a stable injury. If the patient presents with lack of active extension of the DIP joint, then splinting of the finger in extension or slight hyperextension for 8 weeks is the treatment of choice. It is important to educate these patients not to remove the splint. Observed these patients in the office every 1-2 weeks to ensure that the splint is not being removed.

Patients can be instructed to change the splint every few days to allow cleansing of the skin. However, reapplication of the splint should always be completed with assistance. The DIP joint should not be allowed to flex at any time. If the tendon ruptures from DIP flexion, then the entire 8-week period of splinting must be repeated.

When splinting the mallet finger, the DIP joint should not be severely hyperextended, as the skin over the dorsum of the joint will blanch and slough, and ischemia and necrosis of the dorsal tissue may occur. There are cases in which a patient cannot tolerate an external device, and these patients are treated with transarticular Kirschner wire (K-wire) fixation for 6-8 weeks. The PIP joint should be in full motion, because splinting of the PIP may result in thickening of the collateral ligaments and subsequent joint contracture and stiffness.

Rehabilitation is much longer and more difficult with a stiff PIP and mallet finger. However, it should be noted that the PIP joint is infrequently immobilized in the hyperflexible patient to allow the terminal tendon to heal in a shorter position.


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