Exploring Both Surgical & Non-Surgical Treatment Options for Mallet Finger Injuries

Mallet finger injuries are common tendon injuries that involve the finger joints. There are two types of mallet finger. A soft tissue injury is due to a disruption of the tendon as it attaches on the bone, and a bony injury results from an avulsion fracture of the bone. This leads to an imbalance in the forces exerted over the proximal and middle phalanges of the fingers, which if untreated, can result in a physical deformity of the finger, commonly known as a “swan neck deformity”.

Causes of Mallet Finger

Mallet finger usually occurs as a result of sudden forceful flexion of the distal interphalangeal joint (the DIP), which in turn leads to the tearing of the tendon, or a bony avulsion. This is most commonly seen in baseball or basketball players, with a typical presentation of a “jammed” finger”.

Treatment Options

There are several treatment methods for mallet finger, involving both conservative and surgical techniques, but the optimal mode of treatment is at times difficult to ascertain. Splinting is the most common initial mode of treatment, for both a soft tissue and bony mallet finger, but regardless of the type of treatment, some patients might present with a prominent bump on the finger and decreased extension of the finger.

Conservative Treatment: Splinting

With an acute mallet finger, if the deformity is well reduced without further displacement, conservative management with a splint is the indicated mode of treatment. The purpose of a splint is to maintain the DIP in complete extension, so the functional position of the joint is maintained while the healing process continues. Splinting is usually recommended for 6 weeks initially, followed by a period of night splinting for 2-6 weeks.

Physical Therapy

Physical therapy for mallet finger can be done after the splinting period. It has been proven to help in improving finger function and regaining maximum movement and strength, post immobilization, and can also aid in pain reduction. Certain exercises that help strengthen finger flexion, extension, pinching and spreading of the fingers can be initiated with the help of a physiotherapist, once your surgeon provides clearance for PT.

Surgical Treatment

Mallet finger surgery is usually required in open injuries, bony injuries involving larger fragments, an unstable DIP joint, or people in certain professions that demand fine use of the fingers (musicians, surgeons, artists). Multiple surgical techniques have been described, each using a variety of fixation methods (wires, screws, plates, sutures), with good biomechanical fixation.

Is Surgery Necessary?

One question that might arise in the discussion between the patient and provider, is surgery needed for treating mallet finger? In uncomplicated acute cases of mallet finger, splinting provides similar results as surgical treatment. It must be said that surgical treatment carries its own risks and complications. The most common complications that can arise from surgical correction of mallet finger are nail deformities, infection, skin breakdown, redisplacement of the bony fragment and a persistent deformity of the finger.

Importance of Early Treatment

Mallet finger injury can definitely be an impediment and can affect the daily use of the fingers and inhibit certain actions and movements. It is important to address this injury as early as possible, so as to minimize the negative impact of deformity, prevent any future deficits, by correcting it as soon as possible. Whether it is a surgical or non-surgical technique, this allows you to get back to your normal activities without any difficulty. The final decision on the mode of treatment depends on your demands, expectations and the difficulties it is causing you. Please reach out to one of our Rothman hand specialists, and they will guide you on the correct treatment option.