Mallet Finger Injury Management and Treatment Techniques

Mallet finger is characterised by disruption of the extensor mechanism at the distal interphalangeal (DIP) joint, resulting in inability to actively extend the fingertip. Management strategies range from conservative splintage to a variety of surgical interventions, chosen according to fracture displacement, tendon integrity and patient factors. Non‐operative care employs continuous DIP joint extension with custom moulded splints or thermoplastic orthoses for six to eight weeks, followed by gradual mobilisation. Surgical options include extension‐block pinning, hook plate fixation, direct tendon repair with or without Kirschner wires, and mini‐hook plate constructs for small bony fragments. Imaging modalities such as ultrasonography and MRI enhance diagnostic accuracy and inform classification, guiding tailored treatment. Rehabilitation protocols emphasise early controlled motion to minimise stiffness and adhesion, while outcome assessment focuses on extension lag, range of motion and patient‐reported function. Recent advances aim to refine fixation methods, reduce complications such as nail deformity and promote rapid return to activity through minimally invasive techniques and novel implant designs.

Research from Nature Portfolio

Recent studies have demonstrated that high‐frequency ultrasonography offers a non‐invasive, real‐time assessment of both extensor tendon tears and associated bony avulsion fragments at the DIP joint. Compared with radiography, ultrasonography has superior sensitivity for detecting small osseous fragments, while matching MRI in delineating soft‐tissue injury. Based on ultrasound morphology, a new three‐type classification was proposed, distinguishing pure avulsion fractures, isolated tendon ruptures and contusion patterns. This framework has enabled more precise treatment selection and has underpinned efforts to standardise imaging protocols across clinical centres.

Mallet Finger Injury Management and Treatment Techniques publication trend

The graph below shows the total number of articles in mallet finger injury management and treatment techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Distal interphalangeal (DIP) joint: The hinge joint at the fingertip between the middle and distal phalanges.

Extensor tendon: The fibrous structure enabling finger extension, which inserts into the distal phalanx.

Avulsion fracture: A bony fragment torn away at the tendon insertion site.

Hook plate fixation: A small specialised plate with hooks used to secure avulsed bone fragments to the phalanx.

Kirschner wire (K‐wire): A thin, sterile steel pin used for temporary internal fixation of bone or joint position.

Paratenon: The connective tissue sheath enveloping a tendon, whose repair can reduce postoperative adhesion.

References

1. The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury. Scientific Reports (2017).
2. Patient satisfaction after hook plate treatment of bony avulsion fracture of the distal phalanges. European Journal of Medical Research (2018).
3. Clinical outcomes after mini-hook plate fixation for small avulsion fractures around the interphalangeal or metacarpophalangeal joints of the hand. Journal of Orthopaedic Surgery and Research (2021).
4. The Direct Tendon Suture and Paratenon Repair Technique for Acute Tendinous Mallet Finger: A Case Series. Journal of Clinical Medicine (2024).
5. Incidence and management of mallet finger in Dutch primary care. BJGP Open (2023).