Mallet Injury

Introduction

  • Terminal extensor tendon mechanism is disrupted at the base of the distal phalanx (1)
  • Presents with “dropped finger” appearance
  • Injury most commonly occurs in the work environment or during sport participation
  • Symptoms usually include painful and swollen DIPJ
  • Doley's classification is used to grade the mallet fractures.(2)

Assessment

  • When taking a referral or describing it on the phone classify as:
      • closed or open
      • bone or soft tissue (lateral XR will be needed to prove this)
  • Examination usually reveals:
      • Fingertip would usually rest at 45 degrees and active DIP extension would be lost.
  • Hand XR (3)
      • AP, lateral and oblique

management (4)

  • Remove jewellery
  • If passively correctable
      • SPLINT and repeat lateral XR
          • Mallet or Zimmer (keeps PIPJ free) splint
          • A mallet splint should immobilise the DIPJ in slight extension
  • Discuss with senior and book appointment with hand therapists.
      • likely will have a thermoplastic (TP) splint.

References

1. Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544118809050. 2. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 3. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 4. The British Society of Surgery for the Hand. Hand Injury Triage App [Internet]. [cited 2020 Feb 2]. Available from: handinjurytriageapp.bssh.ac.uk
Image References:Header: Licensed with Adobe Stock 2019Doley's Classification table: Made by Viktorija Kaminskaite for PlasticSurgerySHO"Mallet Injury" Image Reference: Licensed under the Creative Commons Attribution-Share Alike 4.0 International license.
This page has been reviewed by: