Mallet Finger Overview
Do I even need a doctor? Can't Mallet Finger heal on its own?
A Mallet Finger can heal without surgery but will need immobilization - in the form of a stax splint, alumafoam splint, or a figure-of-8 splint. Keeping the finger fully straight for eight weeks (six weeks if it is a bony mallet) will allow it to heal.
This means that you must have the finger fully straight while showering, sleeping, working, and doing errands. Do not “test it out” because if you flex the finger at the DIP joint too soon, you may rip any healing tissue and re-injure the finger. Usually, you will be provided with two or three finger splints so that you can change them out while keeping your finger fully straight daily.
It’s important to understand that, unless you take this seriously, a mallet finger can permanently deform the finger. This means that you will never be able to fully straighten your finger, which is a huge problem on its own. In addition, it may cause other joints of the finger to develop a deformity known as “swan neck deformity,” as the flexor and extensor tendons are imbalanced if the mallet finger is not healed, and this imbalance may cause the middle knuckle of the finger to hyperextend.
Mallet Finger Surgical Procedure
Surgery is a rare treatment for mallet finger, and usually involves pins to keep the DIP joint immobilized in extension, or possibly some hyperextension, until the tendon or bone heals.
There are a few criteria that Dr. Kim uses to decide whether or not surgery is necessary.
- There are If there’s a large avulsion fracture;
- There’s an extensive tendon injury;
- There’s joint subluxation or dislocation;
- Conservative treatment failed Mallet finger is chronic.
Surgical repair may be considered when mallet finger injuries have large bone fragments or joint mal-alignment. In these cases, pins, wires or even small screws are used to secure the bone fragment and realign the joint. Surgery may also be considered if splint wear is not feasible or if non-surgical treatment is not successful in restoring adequate finger extension. Surgical treatment of the damaged tendon can include tightening the stretched tendon tissue, using tendon grafts or even fusing the joint straight. Your surgeon will advise you on the best technique in your situation.
Mallet Finger Non-Surgical Treatment
Most mallet finger injuries can be treated without surgery. Ice should be applied immediately, and the hand should be elevated (fingers toward the ceiling.) Medical attention should be sought within a week after injury. It is especially important to seek immediate attention if there is blood beneath the nail or if the nail is detached. This may be a sign of a nail bed laceration or an open (compound) fracture.
There are many different types of splints/casts for mallet fingers. The goal is to keep the fingertip straight until the tendon heals. Most of the time, a splint will be worn full-time for eight weeks. Over the next three to four weeks, most patients gradually begin to wear the splint less frequently. The finger usually regains acceptable function and appearance with this treatment. Nevertheless, it is not unusual to lack some extension at the conclusion of treatment. Your surgeon or hand therapist will instruct you about how to wear the splint and will also show you exercises to maintain motion in the middle joint (the proximal interphalangeal joint) so your finger does not become stiff. Once your mallet finger has healed, your surgeon or hand therapist will teach you exercises to regain motion in the fingertip.
In children, mallet finger injuries may involve cartilage that controls bone growth. Dr. Kim will carefully evaluate and treat this injury in children so that the finger does not become stunted or deformed.
