The finger may be painful, swollen and bruised, especially if there is an associated fracture, but often the only finding is the inability to straighten the tip. Seven patients with chronic bony mallet fingers were treated by dorsal extension block pinning. Most mallet finger injuries are recommended to be treated with immobilisation of the distal interphalangeal joint in extension by splints. However, the treatment of chronic bony mallet finger remains controversial. Sometimes, a piece of bone is taken with it, and this is called a mallet fracture. The goal of this study is to evaluate the clinical outcomes. Mallet finger occurs when the outermost end joint of the finger is injured. Type i closed injury with or without small dorsal avulusion fracture.
A distal phalanx fracture is a disruption of the mechanical integrity of the distal phalanx. Examination and management of finger dislocations and fractures. Finger distal phalanx fractures including mallet finger fracture, fdp tendon avulsion fracture and dip joint volar plate avulsion fracture. This article discusses the current clinical assessment and appropriate management of mallet finger injuries. The first type is called a bony mallet deformity which involves a fracture of the bone. We investigated the use of dorsal extension block pinning with percutaneous curettage for chronic bony mallet fingers. This is a useful technique in management of mallet when presented within 3 weeks duration. Tendinous mallet finger, modified internal suture, anatomical fixation, treatment modality. Degeneration of the dip joint after a mallet fracture injury has been shown to develop. Referral for surgical management of mallet fractures has been suggested for those involving greater than 30 percent of the intraarticular surface and for those associated with volar subluxation. A mallet fracture is an avulsion fracture of the distal phalanx with a bone fragment on the terminal extensor tendon, resulting in unopposed flexion and the inability to actively extend the distal interphalangeal dip joint. There is generally pain and bruising at the back side of the farthest away finger joint. A modified internal suture technique for treatment of the tendinous.
B kwire was tilted proximally and was then advanced through the palmar cortical bone. However, the efficacy of operative treatment and complication rates are unclear regarding the adolescent population. Mallet finger management and patient compliance racgp. However, the optimal treatment of each type of mallet finger injury remains controversial. Fractures of the distal phalanx are the most common fractures that occur in the hand. With mallet finger, the tendon on the back of the finger not the palm side is separated from the joint it connects. Treatment of chronic bony mallet fingers by dorsal. Dorsal extension block pinning is a commonly performed surgical technique for acute bony mallet fingers. A new protocol promoting selfcare was introduced at our institution.
They are the most prevalent finger tendon injury in sport. To look for a fracture an xray is taken of your injured finger. The management of intraarticular fractures of the hand represents a challenge. Mallet injury conservative management a mallet injury is a disruption of the terminal extensor tendon due to laceration, rupture or avulsion fracture. A mallet finger is where the end of a finger is bent flexed towards the palm and cannot. Mallet finger injuries are usually successfully treated nonoperatively with a splint. Management may be operative or nonoperative, depending on the severity of the injury and the patients overall health and functional status. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management. A number of surgical techniques have been described in literature, with variable results. Although nonsurgical treatment for some small fragment cases without distal interphalangeal joint dipj subluxation is acceptable, many authors have considered restoring the joint surface with accurate reduction to be important to prevent secondary osteoarthritis, loss of movement, and poor cosmetic outcomes. There is no consensus on the type of splint and the duration of use. In treating a fracture, the objectives of the treatment are as follows.
C a lateral radiograph taken four months after pin removal demonstrates. Initial management is focused on adequate alignment. The management of mallet fractures varies based on injury pattern and surgeon. For some authors, mallet fractures involving more than. Subsequently, a secondary intraarticular fracture at the base of the distal phalanx occurs as the distal portion of the middle phalanx is driven into the base of the distal phalanx. Surgical treatment of mallet fractures by extension block kirschner wire technique surgical treatment of mallet fractures.
Many surgeons advocate for surgical intervention of adult mallet fractures that involve either subluxation of the distal interphalangeal dip joint or those that involve more than onethird of the articular surface. Thomas splint, skinskeletal traction proximalmidshaft. Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint dip. Treatment of mallet fracture by extension block pinning. They concluded that all mallet injuries could be treated conservatively, regardless of the size of fracture fragment, or presence of subluxation.
Mallet fracture assess for inability to extend at dip joint. Basketball and baseball players routinely experience jammed fingers. Mallet finger usually results from forced flexion of an extended finger. Mallet finger rehabilitation protocol conservative management kelly holtkamp, m. Thus, the risk of poor outcome from illadvised open treatment far outweighs any. The management of closed mallet finger fractures with large and displaced dorsal lip fragments involving more than one third of the dip joint surface remains controversial. Complicatonscomplicatons slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Fracture at the dorsal aspect of the base of the distal phalanx is commonly associated with palmar subluxation of the distal phalanx. Mallet deformity conservative management rehabilitation.
Mallet finger is a flexion deformity resulting from avulsion of the extensor mechanism from the dip joint synonyms for this injury are baseball finger and drop finger, and jamming injuries in ball sports are common the anatomy of the dorsal apparatus of the fingers is. In the case of mallet finger associated with an underlying distal phalanx fracture, surgery is recommended if the fracture involves more than 30% of the articular surface or if there is palmar subluxation of the distal phalanx. The second type is called a soft tissue mallet deformity. Schmidt mallet injury conservative management phase 1. A 45 years old right handed man, manual worker treated by kwj. More commonly only the tendon is injured or the fracture fragment is very small. The bony mallet finger refers to the avulsion fracture at the phalangette basilar part caused by traction of the extensor tendon when the original trauma occurs, leading to a limited extension of. The diagnosis and management of mallet finger injuries gregory.
The current literature describes multiple surgical and nonsurgical techniques for the management of mallet finger injuries, and. A 27yearold man with a 3week injury of the left fi fth fi nger. The mallet deformity can be the ultimate result not only of injuries to. Pdf mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of. This can damage the tendon and bone, causing the finger to droop. The mallet fracture involves more than onethird of the articular surface and sometimes the associated volar subluxation of the distal phalanx. The splint is reduced so long as the dip extension remains at 0 5 8 weeks the mallet splint is discontinued during the day and worn only at night. Surgical treatment of mallet fractures by extension block. Pdf surgical and nonsurgical management of mallet finger. This was a retrospective analysis of patients with old closed bony mallet fingers treated between june 20 and december 2016. A fracture is best described as a soft tissue injury with an associated bony injury.
Introduction missed injuries have been referred to as the trauma surgeons nemesis 1, 2. Type ii open injury laceration type iii open injury deep soft tissue abrasion involving loss skin and tendon substance type iv mallet. Mallet finger is a common injury of the extensor tendon insertion causing an extension lag of the distal interphalangeal joint. Although it is also known as baseball finger, this injury can happen to anyone when an unyielding object like a ball strikes the tip of a finger or thumb and forces it to bend further than it is intended to go.
Mallet finger causes, symptoms and treatment the hand. The aim of the study is to present a new method of open reduction and compression with double kirschner wires kwires in treating old bony mallet fingers. Mallet injury conservative management baycare clinic. Figure 3 from anatomic reduction of mallet fractures using. C with 30o fl exion of the distal interphalangeal joint, a 0. Surgical treatment of mallet fractures with the extension block. A a preoperative lateral radiographic fi nding demonstrates a displaced mallet fracture and a palmar subluxation of the distal interphalangeal joint in the left fifth finger. Patients were provided with structured verbal and written information, and given access to a telephone helpline. The mallet splint is reduced to 4 one hour sessions during the day, along with night wear. Mallet fractures associated with large fracture fragments may result in volar subluxation of the distal phalanx. Mallet fingerfracture a mallet finger happens when the tendon that holds the end of the finger straight is torn from its attachment on the bone.
Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb. Nonsurgical treatment of closed mallet finger fractures. Nonoperative management has been suggested as firstline treatment option for almost all mallet finger injuries. Open reduction and screw fixation of mallet fractures. Treatment of mallet fractures with a transverse twohole.
They may represent an isolated tendinous injury or occur in combination with an avulsion fracture of the basal distal phalanx. Will splint the distal interphalangeal dip joint in extension for 8 weeks. Mallet finger is an injury to the end of your finger that causes it to bend inwards towards your palm. Open reduction and compression with double kirschner wires.
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. A mallet finger, also known as hammer finger, is an extensor tendon injury at the farthest away finger joint. The diagnosis and management of mallet finger injuries. Some aspects of hip fracture management are already covered by nice guidance and are therefore outside the scope of this guideline. Mallet finger is a flexion deformity of the finger that results from injury to the extensor mechanism at the base of the distal phalanx. You will not be able to straighten the end of your finger because the tendon connecting the muscle to the finger bone is stretched or torn. Mallet fracture, mallet finger, extension block, distal interphalangeal joint fracture, surgical treatment 1. The indication for surgery was a fracture involving more than onethird of the distal phalanx articular surface or with subluxation of the distal interphalangeal joint. Pdf nonsurgical management of boney mallet fractures. Mallet finger rehabilitation protocol surgical management kelly holtkamp, m. Mallet finger rehabilitation protocol conservative management. Outcomes following operative treatment of adolescent. Although imaging defines the nature of the fracture, a careful history and physical also helps determine the patients plan of care. Avulsion of the flexor digitorum profundus with a separate intraarticular fracture of the distal phalanx has been proposed as a type 4 injury.
This injury causes a characteristic dip joint extension lag. Of these mallet fractures, twentyone could be followed for a mean of 3. Commonly an athletic injury, mallet finger occurs when the outermost joint of the finger is injured. Finger distal phalanx fracture hand surgery source. Conservative management of this injury is typically successful with. Mallet finger is a flexion deformity of the finger resulting from injury to the extensor mechanism at the base of the distal phalanx. Ankle fracture is one of the most common lower limb fractures for they account for 9% of all frac. The management of old bony mallet fingers is complicated. Mallet finger is an injury to the tip of the finger when something hard, like a baseball, jams it. Functional outcome and satisfaction with a selfcare. Splinting is the most common initial treatment method for. Mallet finger rehabilitation protocol surgical management.