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Mallet Finger

By Danielle Campagne, MD , Department of Emergency Medicine, University of San Francisco - Fresno

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Mallet finger is a flexion deformity of the fingertip caused by avulsion of the extensor tendon, with or without fracture, from the proximal end of the distal phalanx.

The usual mechanism is forced flexion of the distal phalanx, typically when hit with a ball. The extensor tendon may avulse part of the proximal aspect of the distal phalangeal bone (see Figure: Mallet finger.). The avulsed part involves the articular surface.

The affected dorsal interphalangeal (DIP) joint rests in a more flexed position than the other DIP joints and cannot be actively straightened but can easily be passively straightened, usually with minimal pain.

Mallet finger.

The extensor tendon is avulsed from the proximal end of the distal phalanx (top); sometimes the tendon avulses a piece of the distal phalangeal bone (bottom).

Diagnosis

  • Clinical evaluation

  • X-rays

Mallet finger can usually be diagnosed by examining the finger.

Anteroposterior, lateral, and usually oblique x-rays are taken. A fracture, if present, is usually visible on the lateral view.

Treatment

  • Splinting

Treatment is with a dorsal splint that holds the DIP joint in extension for 6 to 8 wk; during this time, the tip cannot be allowed to flex (eg, when cleaning the finger).

Fractures that involve > 25% of the joint surface or that cause joint subluxation may require surgical fixation.

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