Mechanism of Injury

Injuries occur with flexion force while actively extending the DIP joint. 

Symptoms

Loss of active DIP joint extension.

Diagnosis

X-ray to confirm if the mallet finger is a bony or tendon injury.

Referral

Early referral is key to successfully managing these injuries, preferably 1-7 days post-injury. Injuries are considered chronic beyond three weeks post-injury, however, can still be successfully treated.

Management

Literature favours conservative management; however, orthotic preference and wearing regimes differ greatly. 

Management Bony Mallet Injury

• Maintain DIP extension full time for 6-8 weeks.
• Mobilise PIP joint.
• Skin hygiene.
• Graded flexion mobilisation when bone healed.

Management Tendon Mallet Injury

• Maintain DIP extension/hyperextension full time for 6-8 weeks.
• Mobilise PIP joint.
• Skin hygiene.
• Graded flexion mobilisation as tolerated by the tendon.
• If lag occurs, reinstate splinting.
• Watch for swan neck deformity.

Splinting

• No orthosis is superior to another; however, a customised orthosis can result in less complications.
• DIP extension splint full time 6-8 weeks then a further 2 weeks at night time.