Review of Acute Traumatic Closed Mallet Finger Injuries in Adults

Abstract

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury

“…More importantly, compared to MRI, high frequency ultrasonography allows evaluation of real-time function of the extensor tendon through active or passive DIP joint movements. Furthermore, as we all know compared to MRI, ultrasonography was a quicker, more affordable, and less stressing screening choice 11 – 14 . So we can observe the thickness change of injured extensor tendon after treatment by ultrasonography, which is also an important aspect in the following-up 15 , 16 .…”

A comparison of delta wire technique versus extension block pinning in the treatment of bony Mallet finger

“…Bony mallet finger is a deformity caused by avulsion fracture of the distal phalanx at the terminal extensor tendon insertion site. The indications for surgical treatment include: fracture fragment involving more than one third of articular surface on lateral radiograph, palmar subluxation of distal interphalangeal joint (DIPJ), and an open mallet fracture [1,2]. The aim of treatment is to restore anatomy of the terminal extensor mechanism, minimize extension lag, and prevent swan neck deformity [3].…”

“…However, they can be associated with stiffness and osteoarthritis of the DIPJ which may lead to pain and loss of function of the finger. This was thought to be due to the trans-articular K-wire which causes damage to the articular surface of DIPJ [2,6].…”

An unusual presentation of metacarpophalangeal joint instability of the thumb

“… 4 Literature also suggest that non-surgical approach through immobilization, which varies in each case in terms of the position of the splint, type of splint, and the duration of the splint could also be considerate. 5 …”