Scenario: John is a 26 year old who was playing basketball and sustained a mallet injury when the ball hit the end of his finger.
A mallet finger is when the terminal extensor tendon avulses from the distal phalanx with or without a piece of bone, resulting in an inability to straighten the tip of the finger. A mallet injury can be classified into:
• A bony mallet, when the tendon comes off attached to a bony fragment called an avulsion fracture
• A tendinous mallet, where the tendon avulses by itself
For both types of mallet injuries, patients are placed into a splint that holds the distal interphalangeal joint in straight position or slight hyperextension. Bony mallets heal a little faster and the splint can be weaned after 6 weeks, but a tendinous mallet needs splinting for at least 8 weeks. Splints can be made out of a waterproof material of thermoplastic.
Depending on your activity level and needs, your hand therapist will determine what splint is most appropriate for you. Your hand therapist will provide exercises for the uninvolved joints, monitor your splint fit as swelling reduces and ensure the skin has good integrity under the splint.
John may be able to return to basketball at 8 weeks with proper education and splinting for protection. Day to day function is minimally affected by wearing a mallet splint. Better outcomes are associated with early referral. If you suspect a mallet finger please seek medical advice, we would be more than happy to help.