Mallet finger

Synonyms: baseball finger, dropped finger

A drop (a deformity) of the tip of the finger, the distal phalanx, after an injury to the extensor tendon.

In rare cases, it is a diagnostical challenge to distinguish it from a fracture of the fingertip.

It usually develops after sports injury, usually after an impact by a ball, or after a fall, when we land on our fingers. During this types of injuries, only the tendon can be injured but a partial fracture of the fingertip bone can occur. Except for these injuries, which we call closed injuries of the hand, trauma to the fingertips by a sharp object (a cut) can in effect produce the same deformity when a tendon is severed in the cutting.

With blunt force trauma (without an open wound), the basic signs of the injury are:

• pain
• swelling
• bruising
• a drop of the fingertip with no ability to extend it

With more intense injuries, there can be accompanying signs on the finger nail, in the form of a dark bruise or even a separation of the nail from the nail bed.

With sharp injuries, except for aforementioned signs, there is an open wound with bleeding.

Mallet finger is rarely seen as a congenital anomaly.

In most cases, a detailed clinical examination with fingertip extending and flexing function tests is enough, as well as a two way X-ray.

Complications mostly occur due to late or inadequate treatment, and they can be:

• ulceration, maceration and skin necrosis
• infection
• nail deformity
• deformation of the distal joint of the finger
• prolonged, chronic pain
• prolonged swelling

Treatment can be non – surgical and surgical.

Finger immobilization, – it’s applied in all cases of closed injuries with a tendon trauma, and in cases of partial discontinuation of the tendon. Only the fingertip with the distal joint is immobilized, with preservation of the mobility of the finger in other joints. The finger is immobilized in maximum extension, with a splint placed on the dorsal (back) side of the finger, from the tip to the middle joint. The finger is in constant immobilization for 8 weeks, and immobilized during nights for another 2 to 3 weeks. Another 2 to 6 months of constant finger-using exercises are needed, in order to get a good final result. Surgical treatment is rarely needed after this kind of approach.

Tenorrhaphy – it’s applied in all cases when immobilization has not yielded a good result (1 out of 4 cases), when the injury to the finger is more severe, and in all cases of open injuries (when there is a wound). The fundamental goal of this intervention is to establish a continuity of the extensor tendon. In cases of chronic injuries, after a failed immobilization, and with non-treated injuries, a non-functional scar forms on the ends of the tendon, which needs to be removed (excised), before establishing the continuity of the tendon. Immobilization with a needle or a fixating screw is necessary only in rare cases.