Mallet Finger

During one recent basketball session, J. was fortunate not to get any injuries. One friend wasn’t so lucky, unfortunately, as he sustained an injury to a finger when the basketball hit his extending finger head on (axial loading it), either avulsing or tearing the tendon, causing an extensor lag of the distal interphalangeal joint (DIP).

This means the joint cannot be actively extended (i.e. by him extending all his fingers) but can be passively extended (i.e. manually, using his other hand). It is different from a fixed flexion deformity, usually due to joint contracture, where the joint cannot be extended passively or actively.

Said friend was well-versed in orthopaedics and was surrounded by basketball-playing members of the YLL SoM, so he proceeded to do everything according to the books.

  1. PRICEMM

    Previously mentioned in the entry on ankle sprain, PRICEMM. Protection, Rest, Ice, Compression, Elevation, Medication and Modalities.

    There was surprisingly no pain and no tenderness on palpation, hence analgesia was not required. Friend stopped playing immediately, relaxed and manually kept the finger in full extension.

  2. Check-up and X-ray

    The axial loading on the extending finger could havce done one of two things: (a) dorsal avulsion of the proximal part of distal phalanx or (b) complete disruption (Grade III injury, a complete tear) of the extensor digitorum finger.

    The very same day, friend had an X-ray done of his finger which did not show an avulsion, which would be seen in about 20-30% of cases.

  3. Splinting

    Given the lack of an avulsion seen on X-ray, the mallet finger was treated as for a tendon rupture with no option of operative reduction and internal fixation (ORIF) as would be for an avulsion. It was splinted with the DIP extended. Duration of splinting will be for 6-8 weeks.

    However, as friend partakes in multiple competitive athletic activities such as touch rugby, it is recommended that he splints it for an additional 6-8 weeks.

    To complete the picture, the management of a stable avulsion mallet finger is that of splinting for 4 weeks. An unstable one or one involving more than 30% of the DIP requires ORIF.

  4. Watch and wait
  5. A mallet finger caused by a complete avulsion can heal very well with the DIP regaining practically full range of active movement. One caused by tendon rupture heals by fibrosis and causes a slightly reduced range of active movement (slight extensor lag) even if healed maximally. An untreated mallet finger will cause permanent DIP extensor lag.

    The finger should be watched for pressure necrosis from the splint.

    Now that the finger has been adequately splinted, friend can return to normal activity, including his competitive touch rugby.

J. hopes the finger regains maximal range of motion and functionality as soon as possible. Said friend is a kickass basketball player. Updates to follow in 6-8 weeks time.

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