Mallet Finger
Mallet Finger

January 5, 2019

Mallet finger occurs due to the loss in the continuation of the terminal tendon, the extensor tendon in zone 1

Usually occurs due to and extrinsic injury resulting in the rupture of the tendon.

It may be a bony evulsion or a tendon tear

Bony evulsion depending on the size can be treated surgically but most mallet fingers are treated conservatively

Tendon tears are almost always treated with conservative management i.e. splinting.

Most often stack splints are given to patient which prevents the patient for using the finger as it prevents tactile feedback which results in poor compliance. Also, it doesn’t provide good approximation of the finger in hyper extension of the DIP joint

Stack splints also fail to take into account the hyper mobility issues the patients may present with, which requires a different type of splint after careful assessment of the PIP joint of the finger. If not assessed correctly the patient may heal but the finger may still droop due to the hyper mobility of the joint.

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We have been doing dorsal custom splinting with micropore taping 1/2″ to provide tactile feedback and use of the finger for functional activities increasing compliance.

Tape preparation

Video demonstration on the taping technique 

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Enhanced function due to improved tactile feedback

This article was originally written by a surgeon Dr. Burton which was later converted to thermoplastic splint by Dorit Aaron, who taught Charles Costello, who taught me.

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If you detect hypermobility in the joints, especially PIP presenting with hyperextension then a mallet splint will not suffice.

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These patients will benefit from a swan neck splint which provides flexion at PIP joint and hyper extension at DIP joint, thus tightening the lateral bands and providing a better result

For a Mallet with swan finger splint is designed with thermoplastic Proximal to PIP joint is volar and distal to PIP joint is dorsal. A slit is made in a rectangular splint material the width of the finger. Finger is slid through the slit and then molded. It can be secured with tape or velcro