Mallet finger

Mallet finger, what’s it all about?

This is the loss of full active extension of the fingertip joint. It’s the result of an accident that can be as minor as a finger suddenly bent by an obstacle, or as serious as the direct impact of a ball. The finger can no longer be extended because the extensor tendon is ruptured, either in its substance or by tearing off a small fragment of bone

What tests are required?

An examination by a doctor, together with X-rays, enables us to diagnose and differentiate between the two varieties.

How is mallet finger treated?

In the case of tendon rupture alone, treatment is conservative, with a splint holding the fingertip joint in extension for eight weeks to allow the tendon to heal. The plastic splint is custom-made by occupational therapists. It is essential not to remove the splint and flex the finger, otherwise the treatment will have to start all over again. Thereafter, gradual mobilization is permitted, but the splint will be worn for a further four weeks, at night and during activities where there is a risk of impact to the finger. All joints that are not immobilized can and should be used without risk.

Check-ups are carried out at 4, 8 and 12 weeks to ensure that everything is progressing well.

In the event of a fracture, treatment depends on the position and size of the bone fragment. X-rays are used to check whether it is settling back into the splint. If this is the case, the splint is worn permanently for six weeks. X-rays are taken regularly to ensure that the fragment remains in the correct position.

If, on the other hand, the bone fragment is not in the correct position when the splint is applied, surgery is recommended. This is an outpatient procedure performed under local anesthesia (only the arm is asleep). The bone fragment is repositioned and fixed either with pins or small screws.

After the operation, the finger is immobilized in the same splint for a period that varies according to the stability of the fragment fixation, but ranges from 3 to 6 weeks. Regular X-rays ensure that the set-up is stable and that consolidation is proceeding smoothly. Once consolidation has been achieved, the pins are removed under local anaesthetic. If one or more screws have been used, they are removed according to the degree of discomfort felt. A final check-up takes place at 3 months to ensure that the finger has recovered properly.

The duration of any work stoppage depends on the profession, and can range from a few days to several weeks. We advise against sports activities involving the risk of impact on the injured finger until the tendon has healed or the bone has consolidated (two to three months).

What are the possible complications?

• Non-surgical treatment

Sometimes the tendon or bone doesn’t heal sufficiently, and the fingertip doesn’t return to its full upright position. If the lack of extension is significant, surgery may be proposed. If it’s not very marked, it’s sometimes more reasonable to leave the situation as it is, as long as it doesn’t cause a handicap.

The finger splint can cause a wound (eschar) if there is excessive localized pressure. That’s why it’s important to report any discomfort caused by the brace.

After wearing the splint, the finger sometimes becomes thinner, but this quickly normalizes.

• Surgical treatment

Common to all surgeries

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.

Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

Complications specific to mallet finger

The operated joint may retain a certain degree of stiffness permanently, meaning that mobility is no longer as good as before the accident.

Sometimes, the bone fragment consolidates in an imperfect position, either because it moves over the weeks, or because the initial lesion was severe. This can lead to long-term osteoarthritis, i.e. wear and tear of the cartilage, resulting in pain, deformity and lack of mobility. In some cases, further surgery may be required to correct the position of the bone fragment.