Mallet Finger

Mallet finger is a common condition often caused by “jamming” a finger. The extensor tendon near the base of the finger nail is torn from its attachment. Sometimes this is associated with a fracture of the bone (“bony mallet”), while other times it is an injury only of the tendon (“soft tissue mallet”). This results in the finger tip “drooping” down and unable to extend to fully straightened at the DIP joint (the final joint before the finger nail). Not treating this can result in both a persistent deformity of the fingertip and risk of tendon imbalance causing additional deformity in the finger known as a “swan neck deformity”.

A history of the injury and the clinical appearance of the finger where it is unable to be fully straightened typically is sufficient to make the diagnosis of a mallet finger. An x-ray should then be performed to determine whether there is an associated fracture or subluxation (partial dislocation). The finger is then assessed for the amount of extensor lag or “droopiness”.

Many of these injuries are amenable to treatment with a splint that immobilizes only the affected joint in full extension. Typically, this splint must be worn 24/7 for at least 6 weeks. It is critical that the splint is worn at all times. If the finger is allowed to bend during the treatment, this often requires another 6 weeks or more of treatment from the time at which the finger was bent.

For more severe injuries with a larger fracture fragment or subluxation of the distal phalanx or for certain patients who are unable to wear a splint for the full duration of treatment, surgery is a treatment option. This often involves placement of metal wires to hold the bones in position while the tendons and/or bones heal in appropriate position.

Post-operative pain usually is relatively mild and often requires only over the counter medications such as acetaminophen and ibuprofen. Recovery from surgery typically requires immobilization of the affected joint until removal of the metal wires, typically at 6 weeks post-operatively.

With non-operative or operative treatment, there may be a very mild residual deformity of the finger where it remains slightly bent at the fingertip. There may also remain a bump on top of the joint where there is residual swelling or a small bone fragment.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with mallet finger from across the Bay Area and Northern California. Contact us to schedule a consultation.

Below are links for third party resources

American Society for Surgery of the Hand

American Academy of Orthopaedic Surgeons