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A patient, aged 16 years, presented with pain and deformity of the right middle finger. He reported injuring the finger playing football two days prior. He was unable to extend the tip of his finger since the injury.
On exam, a flexion deformity at the distal interphalangeal joint was found. The patient was unable to extend his distal phalanx. Anteroposterior (AP) and lateral x-rays were taken.
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The x-rays show a bony mallet finger. Bony mallet fractures result from a forceful impaction to the distal phalanx causing the extensor tendon to pull off a piece of bone. The patient should be treated in a volar splint at all times for six weeks.
Bony mallet fingers have been shown to do well with nonsurgical management when patients are compliant with strict immobilization. Relative surgical indications include volar subluxation of the distal phalanx and greater than 50% articular surface involvement.
Dagan Cloutier, MPAS, PA-C, practices in a multispeciality orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
- Abbassi D. Mallet finger. Last updated 12/08/2014 from http://www.orthobullets.com/hand/6014/mallet-finger.
- Bendre AA, Hartigan BJ, Kalainov DM. JAAOS. 2005; 13: 336-344.
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