Mallet finger is a deformity of the finger caused by damage to the extensor tendon
The extensor tendon is the tendon that allows the tip of the finger to straighten. When a ball or other object strikes the tip of the finger, the force causes the tendon to detach from the bone. The force of the blow may even pull away a piece of bone along with the tendon.
The finger is often painful, although it can be painless. There may be swelling and bruising. The fingertip may droop noticeably.
Although mallet finger is diagnosed with only a clinical exam, x-rays are done to determine whether there is bony involvement, as this may change the proper treatment.
Many mallet finger injuries can be treated without surgery, as long as the patient is evaluated by the healthcare provider soon after the injury.
A finger cast may be applied to hold the finger in extension for 6-8 weeks. Typically a cast changed is scheduled mid-way through treatment to ensure there is still a good fit once there is less swelling. If the cast becomes loose at any time, it is imperative that it not be removed, and that you return to be re-casted, as any movement of the finger tip will cause the 6-8 week period to start over. Once the cast is removed, the patient will often go into a removable splint, which will be used less and less frequently over the following month or so.
Although the finger usually regains an acceptable function and appearance with this non-surgical treatment plan, many patients will not regain full fingertip extension.
Surgical repair is considered when the mallet finger injury is severe, when it is an old injury (over about 2-3 weeks old), has bony involvement, or if non-surgical treatment has failed.
Typically a temporary pin is used to keep the finger in full extension. If there is bony involvement, a second pin will be inserted into the fracture site to allow strong healing of the fracture. A cast may be applied over this. The pins are removed several weeks later.
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