Orthopaedic Hand Trauma CH32 (1)

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CHAPTER 32  | Mallet Finger

■ ■ Patients will most commonly endorse painful and/or swollen DIP joint as the primary complaint. In addition, patients will complain of an inability to extend the DIP joint. ■ ■ On examination, the patient will have a painful and swollen DIP joint with the joint held in flexion ( Figure 32.3 ). The patient will lack the ability to actively extend the tip of the finger. ● ● It can often be difficult to note a DIP joint resting in flexion because of the amount of joint swelling.The examiner can passively (hyper)extend the DIP joint and ask the patient tomaintain this position. Patients with a mallet finger will not be able to maintain extension of the fingertip. ■ ■ Plain radiographs can reveal a bony avulsion of the dorsal lip of the distal phalanx articular surface ( Figure 32.4 ). If the injury is purely tendinous, the DIP joint will appear to rest in flexion without a bony avulsion ( Figure 32.5 ). ■ ■ There are two classification systems that are used most commonly: ● ● Wehbe and Schneider —describes injury severity ( Table 32.1 ) ● ● Doyle —describes injury pattern ( Table 32.2 )

ACUTE MANAGEMENT

■ ■ DIP joint splinting is the most common initial treatment for either tendinous or bony mallet fingers.

Figure 32.3  Clinic photograph of mallet finger injury.