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Mallet Finger

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Isang plano ng paggaling na pinamumunuan ng splint para sa mallet finger, kung saan pinapanatiling ganap na tuwid ang joint ng dulo ng daliri nang walang putol-putot sa loob ng humigit-kumulang anim hanggang walong linggo upang makapagpagaling ang extensor tendon, habang ang ibang mga joint ng daliri ay patuloy na gumagalaw.

Illustrasyon ng mallet finger: ang dulo ng daliri ay bumababa at hindi naaayos, habang ang gitnang kasukasuan ay hindi apektado.
Sa mallet finger, ang terminal extensor tendon ay nahihilom sa huling kasu-kasuan (ang DIP), kaya ang dulo ng daliri ay bumababa at hindi kayang tuwidin nang aktibo; ang paggamot ay pag-splint ng kasu-kasuan na iyon nang tuwid nang walang putol habang ito ay nagpapagaling. Holly Cheng / Wikimedia Commons, CC BY-SA 3.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay gabay sa iyong paggaling mula sa mallet finger (isang pababa na dulo ng daliri na dulot ng pinsala sa tendon na nagpapatuwid sa pinakahuling kasukasuan ng daliri), sa ilalim ng pangangalaga ni Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton. Karamihan sa mga kaso ng mallet finger ay ginagamutan nang walang operasyon, gamit ang splint na pinapanatiling tuwid ang dulo ng daliri habang ito ay gumagaling. Nagsisimula ito sa iyong home program, sinundan ng istrukturadong klinikal na protocol na isinulat para sa iyong hand therapist. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa therapy upang manatiling koordinado ang iyong rehabilitasyon. Maaaring baguhin ng iyong therapist ang plano depende sa kung paano ang iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa daliri, ang balat sa ilalim ng splint, o sa iyong pag-unlad, makipag-ugnayan sa mga kwarto. Karaniwang makakatulong na kumuha ng litrato at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang mallet finger ay nangyayari kapag ang terminal extensor tendon (ang manipis na tendon na nagpapatuwid sa pinakahuling kasukasuan ng daliri, ang DIP na nasa tabi ng kuko) ay naputol o naputol mula sa buto. Karaniwan itong sumusunod sa isang pinilit na pagbaluktot ng tuwid na dulo ng daliri, tulad ng pagtama ng bola o isang "paghampas" sa dulo ng daliri. Minsan, humihila ang tendon ng maliit na piraso ng buto kasama nito (isang bony mallet); minsan, naputot lamang ito (isang tendinous mallet). Sa parehong kaso, ang resulta ay pareho: ang dulo ng daliri ay bumababa at hindi mo ito maipatwid nang sarili, kahit na normal ang paggalaw ng iba pang bahagi ng daliri.

Ang magandang balita ay ang sugatang ito ay gumagaling nang maaasahan lamang sa pamamagitan ng paggamit ng splint; hindi kailangan ng operasyon para sa karamihan ng mga tao. Ang buong paggamot ay nakasalalay sa isang simpleng prinsipyo:

  • Ang kasukasuan ng dulo ng daliri ay dapat hawakan nang ganap na tuwid, nang walang paghinto, habang gumagaling ang tendon. Isang splint ang nagpapanatili sa huling kasukasuan na tuwid (o bahagyang nakabaluktot pabalik) upang ang mga naputol na dulo ay makapag-ugnay. Ito ay isusuot nang buong oras (gabi at araw) ng mga walong linggo para sa isang tendinous mallet o mga anim na linggo para sa isang bony mallet.
  • Ang dulo ng daliri ay hindi dapat payahang lumukat sa panahong ito. Kung ang dulo ay bumaba kahit sandali (halimbawa, habang nagbabago ng splint o naghuhugas), ang paggaling ay mabubura at ang oras ay magsisimula muli mula sa zero. Dahil dito, ang kung gaano kaingat mong pinapanatili ang tuwid na dulo ng daliri ang nagiging pinakamalaking salik sa kung gaano kagaling ang daliri.
  • Ang iba pang kasukasuan ng daliri ay mananatiling malaya at patuloy na gumagalaw. Ang gitnang kasukasuan (PIP) at ang knuckle (MCP) ay hindi kasama sa splint at dapat galawin nang malaya mula sa simula; ang paggalaw nito ay hindi nakakaapekto sa paggaling ng dulo ng daliri.

Pagkatapos ng buong panahon ng paggamit ng splint nang buong oras, ang splint ay unti-unting binabawasan (una ay gabi at paggamit lamang sa mga aktibidad na may panganib, pagkatapos ay tinatanggal) habang dahan-dahang muling nagsisimula kang lumukot ng dulo ng daliri. Karaniwan na magmanatili ng bahagyang permanenteng pagbaba ng mga limang hanggang sampung degrees; inaasahan ito, karaniwan ay hindi nakakaapekto sa pagganap ng daliri, at karamihan sa mga tao ay napakasaya sa resulta.

Mga Paalala at Limitasyon

  • HINDI KAILANMAN hayaang yumuko ang dulo ng daliri habang nasa yugto ng paggamit ng splint, kahit isang segundo lamang kapag nagliligo o nagpapalit ng splint. Kung ito ay yumuko, mababawi ang paggaling at magsisimula muli ang panahon ng paggamit ng splint.
  • Isuot ang splint nang buong oras (gabi at araw) sa buong panahon na itatakda ng iyong terapeuta: mga 8 linggo para sa tendinous mallet, at mga 6 linggo para sa bony mallet.
  • Tanggalian lamang ang splint upang linisin at patuyuin ang balat, at lamang kung kayang panatilihin ang dulo ng daliri na tuwid nang buong oras (ihiga ito nang patag sa mesa o hawakan nang tuwid gamit ang iyong ibang kamay).
  • Panatilihing malaya ang paggalaw ng gitnang kasukasuan at knuckle mula sa simula; ang hawak na tahimik ay ang pinakadulo lamang na kasukasuan.
  • Suriin ang balat araw-araw. Ipabatid sa iyong terapeuta sa kamay kung ang balat sa itaas ng kasukasuan ay magiging maputla, puti, o masakit; maaaring hinihila pabalik ng splint ang dulo ng daliri nang sobra at nangangailangan ng pag-aayos.
  • Huwag magsimulang yumuko ng dulo ng daliri hanggang sa magsimula ang yugto ng pagbabawas ng paggamit ng splint ng iyong terapeuta sa kamay.

Para sa pamamahala ng sugat, pamamaga, at balat, tingnan ang gabay ng klinika tungkol sa pangangalaga sa sugat.

Mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Ang pinakamahalagang "ehersisyo" ay simpleng suotin ang iyong splint nang tama at panatilihing tuwid ang dulo ng daliri sa bawat sandali; ang lahat ng iba ay nakabase dito. Sa maagang yugto, ang iyong tungkulin ay panatilihing nakasuot ang splint, panatilihing malusog ang balat, at panatilihing malayang gumagalaw ang mga ibang joint ng daliri. Ang mga banayad na ehersisyo sa pagbaluktot ng dulo ng daliri at pagharang sa pagtutuwid ay kabilang sa huling yugto ng pagbabawas ng splint at hindi dapat simulan hanggang sa tiyak na simulan ito ng iyong hand therapist. Itigil ang anumang gagawa ng pagbaba ng dulo ng daliri at bumalik sa full-time na paggamit ng splint.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang yugto-yugto na klinikal na protokol para sa rehabilitasyon ng mallet finger na pinamumunuan ng splint. Ang seksyong ito ay dapat ibigay sa hand therapist, at ang bawat yugto ay nagsisimula sa isang paliwanag sa simpleng wikang Ingles kung ano ang nangyayari. Ang paggaling ay nakadepende sa walang putol na extension ng DIP: ang terminal tendon (o ang avulsed na bony fragment) ay mag-uunite lamang kung ang DIP ay hindi hinihayaan na lumukob (flex) sa loob ng panahon ng pag-splint, habang ang PIP at MCP ay pinapalaya, dahil ang kanilang galaw ay hindi nakakaapekto sa paggaling ng terminal tendon. Ang compliance ng pasyente ang pangunahing driver ng resulta.

Bago ang paggamot, kumpirmahin kung ang mallet ay tendinous o bony at suriin ang imaging. Ginagamit ang DIP extension orthosis: Stack, thermoplastic, o volar/dorsal alumifoam; ang uri ng splint ay walang makabuluhang epekto sa resulta, kaya pumili batay sa fit, toleransya ng balat at compliance. Panatilihin ang DIP sa full extension o bahagyang hyperextension, ngunit I-ELIWAN ang sobrang hyperextension (risk ng dorsal-skin blanching/ulcer). Para sa bony mallet, mas mainam ang straight/neutral DIP kaysa hyperextension upang maiwasan ang volar subluxation ng distal phalanx. Ang PIP ay palaging pinapalaya.

Yugong I — tuloy-tuloy na full-time na extension splinting (linggo 0 hanggang 6/8)

Ang joint ng dulo ng daliri ay panatilihing tuwid, araw at gabi, upang ang tendon o fragment ng buto ay magaling. Ang splint ay tatanggalin lamang para sa pag-aalaga ng balat, at kailangang panatilihing extended ang DIP sa buong panahon; ang anumang pagkakataon ng flexion ng DIP ay magre-reset ng oras ng paggaling. Ang PIP at MCP ay malayang gumagalaw.

Para sa iyong hand therapist:

Edukasyon at mga paalala - Mag-fit ng DIP extension orthosis (Stack/thermoplastic/alumifoam), ang DIP ay nasa full extension o bahagyang hyperextension; iwasan ang sobrang hyperextension (pagpapaputi ng balat/ulcer); bony mallet → tuwid/neutral, hindi hyperextended (risk ng subluxation) - Tuloy-tuloy na pagsuot: tendinous ~8 linggo, bony ~6 linggo; ang DIP ay hindi kailanman dapat yumuko (flex) sa loob ng panahong ito - Ituro ang teknik ng pagpapalit ng splint sa patag na ibabaw upang hindi hayaang bumaba ang DIP; kung hindi mapanatili ng pasyente ang extension, ang therapist ang gagawa ng pagpapalit - Iwanang malaya ang PIP at MCP at aktibong galawin mula araw 1

Pamamahala - Balat: araw-araw na inspeksyon sa dorsal DIP at nail fold; i-adjust ang orthosis kung may pagpapaputi o pressure; panatilihing malinis at tuyo - Oedema: elevation; banayad na galaw ng proximal joints - Mga ehersisyo: buong active PIP at MCP ROM; walang galaw ng DIP - Bony mallet: panatilihin ang radiographic surveillance habang nagsisplint (alignment/subluxation), dahil ang splinting ay hindi mas mababa kaysa pinning para sa extensor lag ngunit kailangang monitor ang posisyon ng fragment

Mga pamantayan para mag-progress - Kumpletong panahon ng full-time na nakapagsuot (tendinous ~8 linggo / bony ~6 linggo) na may walang DIP extensor lag na higit sa tanggap na halaga, at malusog na balat

Yugto II — pagbaba ng splint at pagsisimula ng kontroladong galaw ng DIP (linggo 6/8, pagkatapos +2 hanggang 6)

Kapag tapos na ang panahon ng buong-oras na paggamit at wala o tanggap lamang ang extensor lag, ibababa ang paggamit ng splint sa gabi at sa mga aktibidad na may mataas na panganib habang sisimulan ang mahinahon at kontroladong DIP flexion. Maaaring ituring na opsional ang paggamit ng splint sa gabi (isang pag-aaral na antas-I ay nagpakita na hindi ito kinakailangan) at ginagamit ito nang praktikal. Kung bumalik ang malaking lag, babalik ang pasyente sa buong-oras na paggamit ng extension splint.

Para sa iyong hand therapist:

Pagsusuri - DIP active extension lag (degrees) at active flexion; balat; kumpiyansa ng pasyente sa paglalabas ng dulo ng daliri mula sa splint

Edukasyon at mga paalala - Ibaba ang paggamit ng splint sa gabi at sa mga aktibidad na may mataas na panganit ng mga sumunod na 2 hanggang 6 linggo; ang paggamit sa gabi ay opsional base sa kasalukuyang ebidensya - Kung bumalik ang extensor lag na >20° pagkatapos ng paggamit ng splint, ibalik ang buong-oras na paggamit ng extension splint ng mga ~4 hanggang 6 linggo

Pamamahala - Mga ehersisyo: simulan ang mahinahon at unahan-unahang active DIP flexion (maliit na range muna) at blocked active DIP extension (i-stabilize ang PIP, i-extend ang DIP); dagdagan ang range ng flexion habang pinapayagan ng lag - Bawasan ang paggamit ng splint sa araw kapag ang DIP ay nakakapanatili ng extension nang active na walang o tanggap lamang (≤10–20°) na lag - Patuloy na gumagawa ng PIP/MCP motion; pangangalaga sa peklat/balat kung kinakailangan - Ang mga chronic o delayed-presentation na mallet finger ay tumutugon pa rin sa extension splinting; ang pagka-delay ng simula ay hindi hadlang sa paggamit nito

Mga pamantayan para mag-advance - Ang DIP ay nakakapanatili ng active extension na may tanggap na lag; nakakuha na ng controlled, walang sakit na DIP flexion; intact ang balat

Yugto III — pagpapalakas at pagbabalik (mula mga linggo 8 hanggang 12)

Kapag gumaling na ang tendon at naibalik ang aktibong galaw, ang daliri ay ganap na tinatanggal sa splint at nagsisimula ang unti-unting pagpapalakas at pagbabalik sa aktibidad. Inaasahan ang maliit na permanenteng extensor lag (mean ~8°) at ito ay naaayon sa mahusay na resulta sa pagganap.

Para sa iyong hand therapist:

Pagsusuri - DIP active extension lag at flexion arc; grip; handa para sa pag-load at sports

Edukasyon at mga paalala - Araw-araw na paggamit nang walang splint; protektibong splinting para sa contact sport habang bumabalik - Magbigay ng payo na ang natitirang ~5–10° extensor lag ay normal at hindi nakakaapekto sa kasiyahan

Pamamahala - Mga ehersisyo: unti-unting pagpapalakas ng grip at pinch; buong ROM ng daliri; pag-unlad na nakatuon sa gawain at espesipiko sa sports - Pagbabalik sa sports/mabigat na trabaho mula mga linggo 8 hanggang 12 batay sa mga pamantayan (protektibong splint para sa contact sport) - Magdischarge kapag sapat na ang lakas at pagganap at matatag na ang lag; mag-refer pabalik kung nananatili o bumabalik ang malaking lag

Pagbabalik sa trabaho at gawain

Ang magaan na paggamit ng kamay na may splint ay okay mula sa simula: mananatiling naka-splint ang kamay, mananatiling tuwid ang dulo ng daliri, at maaari mong gamitin ang kamay para sa mga pang-araw-araw na gawain hangga’t nasa limitasyong ito. Karaniwang hindi hadlang ang maliit na splint sa dulo ng daliri sa pagmamaneho kapag nakakapit ka na sa manibela at nakakontrol ng sasakyan nang ligtas, ngunit itanong ito kay Dr. Hirpara sa iyong follow-up. Ang pagkapit at pagpapalakas ng lakas ay unti-unting tataas mula sa anim hanggang walong linggo, habang unti-unting binabawasan ang paggamit ng splint. Ang pagbabalik sa sports at mas mabigat na manual na trabaho ay karaniwang mula sa walo hanggang labindalawang linggo, at itinataya base sa pagbawi ng kontroladong galaw kaysa sa kalendaryo lamang, at ginagamit ang protektibong splint sa panahon ng pagbabalik sa contact sports. Inaasahan ang bahagyang permanenteng pagbaba ng dulo ng daliri na humigit-kumulang limo hanggang sampung degrees; ito ay normal, hindi nakakaapekto sa pagganap ng kamay, at halos hindi napapansin ng karamihan.

Pagkatapos ng iyong protokol

Ang protokol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika; tingnan ang pamamahala ng post-operative na sakit, pag-aalaga sa sugat, at pamamahala ng peklat. Ang naka-ayos na plano sa itaas ay sumasalamin sa inilathala na gabay para sa paggamit ng splint sa mallet finger, at ang iyong patuloy na paggaling ay indibidwal na pinamamahalaan ni Dr. Hirpara at ng iyong hand therapist ayon sa pag-unlad ng iyong dulo ng daliri.

Isang paalala kung ang iyong mallet finger ay aayusin sa pamamagitan ng operasyon

Karamihan sa mga kaso ng mallet finger ay hindi kailangan ng operasyon. Ang operasyon ay isinasalang-ala lamang para sa bony mallet kapag ang fracture ay sumasaklaw sa malaking bahagi ng ibabaw ng kasu-kasuan (higit sa mga isang-katlo) o kapag ang huling kasu-kasuan ay lumilipat sa hindi tamang posisyon (volar subluxation). Kapag ginawa ang fixation, karaniwan itong extension-block (Ishiguro) K-wiring, minsan ay may kasamang pansamantalang wire na dadaan sa kasu-kasuan ng dulo ng daliri upang panatilihin ito sa tuwid na posisyon. Ang wire na ito ay karaniwang pinapanatili sa loob ng mga apat hanggang anim na linggo at tinatanggal sa paligid ng limang hanggang anim na linggo, pagkatapos nito ay magsisimula ang aktibong paggalaw ng dulo ng daliri at maaaring isuot ang night splint sa loob ng mga apat pang linggo. Ang ebidensya ay nagpapakita na ang paggamit ng splint ay hindi mas mahina kaysa sa paggamit ng pin para sa huling dami ng pagdapa, kaya ang operasyon ay inilalaan lamang para sa mga partikular na sitwasyon na nabanggit sa itaas imbes na gamitin nang regular.

Reviewed by Dr Kieran Hirpara · 20 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Mallet Finger — Injury Outcomes & Splint-Led Rehabilitation (Terminal Extensor Tendon, DIP)

Topic scope: non-operative (and, where indicated, post-fixation) management of a mallet finger — disruption of the terminal extensor tendon at the distal interphalangeal (DIP) joint, either purely tendinous or with an avulsion bony fragment (bony mallet). This is a healing injury, not a reconstruction: the entire treatment is uninterrupted DIP extension splinting that holds the tendon (or fragment) in apposition while it unites, with the PIP and MCP left free.

Defining principle of the rehab here: the terminal extensor tendon heals only if the DIP is held in continuous extension and is never allowed to flex during the splinting period. Any single lapse into DIP flexion separates the healing ends and restarts the healing clock, which is why patient compliance is the dominant outcome driver. The PIP is deliberately kept mobile because proximal-joint motion does not disturb terminal-tendon healing. Splint type (Stack, thermoplastic, volar/dorsal alumifoam) does not materially change the outcome — fit, skin tolerance and compliance matter more than the device. The single branch point is the bony mallet with a large articular fragment or DIP volar subluxation, where surgical fixation is considered; even there, splinting is non-inferior to pinning for the final extensor lag, so operation is reserved rather than routine.

A. INJURY OUTCOMES (tendinous vs bony mallet; splinting vs fixation)

Mallet finger is one of the most reliably treated closed tendon injuries in the hand: the great majority heal well with splinting alone, and the principal debate is over the bony mallet — when, if ever, to fix it.

  • Continuous extension splinting is the standard of care and works well for both tendinous and bony mallets, including chronic and delayed presentations, which still respond to splinting weeks after injury [Valdes systematic review LoE 1a; Salazar Botero review; Medscape; StatPearls]. Strong (SR + reviews).
  • Splint type makes no meaningful outcome difference. A randomised comparison of splint designs found no superiority of one orthosis over another; the determinant is uninterrupted DIP extension and compliance, not the device [Pike RCT]. Strong (RCT).
  • Splinting is non-inferior to extension-block pinning for the final extensor lag. A randomised trial comparing conservative extension splinting with operative extension-block K-wiring for bony mallet found no advantage to pinning in the residual lag, supporting non-operative management as the default even for many bony mallets [Thillemann RCT]. Strong (RCT).
  • Surgery is reserved for the large bony fragment or subluxating DIP. Operative fixation is considered when the fracture involves a large part of the articular surface (often cited as

    ~30%) or there is volar subluxation of the distal phalanx; common techniques are extension-block (Ishiguro) K-wiring with or without a trans-articular DIP pin. Single-K-wire constructs perform less well in non-compliant settings [Aksan; Salazar Botero; Medscape]. Moderate.

  • Stack splints can subluxate a bony mallet. Volar-based Stack-type orthoses holding the DIP in hyperextension can displace a bony-mallet fragment / promote subluxation, which is why a straight/neutral DIP is preferred for bony mallets rather than hyperextension [Kaplan]. Moderate (mechanistic/clinical).
  • The underlying mechanism is a terminal tendon avulsion at the distal phalanx. Anatomical and injury studies characterise the lesion as avulsion of the terminal extensor at its distal-phalanx insertion, and a very small amount of tendon lengthening translates into a large extensor lag — roughly 1 mm of lengthening ≈ 25° of lag — which is the biomechanical reason apposition must be maintained so strictly [Tuttle; Yeh; PMC current concepts]. Mechanistic.

B. REHABILITATION / THERAPY EVIDENCE

The central rehab questions are (1) how long and how strictly to splint, (2) whether the PIP should be included, and (3) whether night-time and post-splinting splinting are needed. The evidence supports uninterrupted full-time DIP extension splinting (~6–8 weeks) with the PIP free, followed by a weaning phase, and downgrades routine night-splinting to optional.

  • Uninterrupted DIP extension is the active ingredient; the PIP must stay free. Splinting holds the DIP in full extension (or slight hyperextension) continuously; the PIP and MCP are mobilised from the outset because proximal-joint motion does not load the terminal tendon. Full-time wear is about 8 weeks for tendinous and 6 weeks for bony mallets [Valdes SR 1a; Salazar Botero; StatPearls; Physiopedia]. Strong (SR + guideline-level reviews).
  • Compliance is the dominant outcome driver. Because any DIP flexion restarts healing, outcome tracks adherence to continuous extension more than any device choice; patient education and a safe flat-surface splint-change technique are central [Valdes SR; Cook BAHT survey of therapist practice]. Strong (mechanism + practice consensus).
  • Avoid excessive hyperextension. Holding the DIP in marked hyperextension risks dorsal-skin blanching and pressure ulceration over the joint; slight hyperextension or neutral is sufficient, and bony mallets should be held straight/neutral to avoid fragment subluxation [Azad dorsal splinting outcomes; Kaplan]. Moderate.
  • Night-time splinting after the full-time phase is non-essential (optional). A Level-I study found that continued night-splinting after the primary full-time period was not essential to the result, so the ~2–6 week post-splinting night/risky-activity phase is framed as optional and pragmatic rather than mandatory [Valdes SR 1a evidence base]. Moderate (Level I within SR).
  • Recurrent lag responds to re-splinting. If an extensor lag (>~20°) recurs after the splinting period, a further ~4–6 weeks of full-time extension splinting is appropriate; chronic/delayed mallets likewise still respond [Salazar Botero; Medscape; StatPearls]. Moderate.
  • A small residual extensor lag is the expected, satisfactory result. Most patients are left with a slight permanent lag (mean ~8°, typically 5–10°) that does not impair function or satisfaction; this should be counselled as normal rather than as failure [Salazar Botero; PMC current concepts; Physiopedia]. Moderate–strong (natural history).

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
I — Continuous DIP extension splinting Week 0–6/8 (bony ~6, tendinous ~8) DIP held continuously extended; never flex the DIP Full-time extension orthosis (Stack/thermoplastic/alumifoam); flat-surface splint changes only; PIP + MCP moved freely from day 1; daily dorsal-skin checks No DIP loading; light splinted hand use Any DIP flexion resets the clock; bony mallet held straight/neutral + radiographic surveillance
II — Weaning & controlled DIP motion +2–6 weeks after full-time phase Night / high-risk-activity splinting (night wear optional) Begin gentle graded active DIP flexion + blocked active DIP extension; reduce day wear once lag ≤10–20° Light functional load Lag >20° recurring → re-splint full-time ~4–6 wk; chronic mallets still respond
III — Strengthening & return From ~week 8–12 None (protective splint for contact sport) Splint-free use; graded grip/pinch strengthening; full ROM; sport-/work-specific progression Grip/strength built up; driving once able to grip the wheel safely Expect ~5–10° permanent lag (mean ~8°) — normal, satisfaction preserved

(Phase windows mirror the precautions in the patient protocol; they are typical guides, not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Splint type. Stack vs thermoplastic vs volar/dorsal alumifoam — randomised data show no meaningful outcome difference; the determinant is uninterrupted extension and compliance, not the device [Pike RCT]. Strong evidence of equivalence.
  2. Splinting vs operative fixation for bony mallet. Randomised data show extension splinting is non-inferior to extension-block pinning for the residual lag; surgery is reserved for the large articular fragment (>~30%) or volar DIP subluxation, not used routinely [Thillemann RCT; Aksan; Salazar Botero]. Strong (RCT) for non-inferiority; moderate for the fixation indications.
  3. Hyperextension vs neutral. Slight hyperextension aids tendinous apposition but excessive hyperextension risks dorsal-skin ischaemia/ulcer, and in bony mallets can subluxate the fragment — hence straight/neutral for bony mallets [Azad; Kaplan]. Moderate.
  4. Is night-splinting necessary? A Level-I study found continued night-splinting after the full-time phase non-essential; the post-splinting phase is therefore optional/pragmatic rather than mandatory [Valdes SR 1a]. Moderate.
  5. Residual lag as expected outcome, not failure. A small permanent lag (mean ~8°) is the norm and is compatible with full function and satisfaction; mislabelling it as failure drives unnecessary intervention [Salazar Botero; PMC current concepts]. Strong natural-history data.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (RCT / SR): uninterrupted DIP extension splinting as standard of care (6–8 wk full-time, tendinous ~8 / bony ~6); splint-type equivalence; PIP-free mobilisation; compliance as the key outcome driver; expected ~5–10° residual lag; splinting non-inferior to pinning for bony mallet (with radiographic surveillance during splinting).
  • MODERATE: exact length of the weaning/night-splinting phase (night wear non-essential per a Level-I study); strengthening and return-to-sport/work timing (~8–12 weeks, criterion-based); hyperextension-vs-neutral splint positioning and the bony-mallet subluxation caveat; surgical indications (>~30% articular fragment / volar subluxation) and fixation technique.
  • WEAK / CONFIRM: driving — a fingertip splint is not usually a contraindication once the wheel can be gripped safely, but this is confirmed clinically rather than evidence-defined.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • A randomized controlled trial comparing splint designs for mallet finger. J Hand Surg Am. 2010. DOI: 10.1016/j.jhsa.2010.01.005
  • Conservative management of mallet finger: a systematic review (Level of Evidence 1a). J Hand Ther. 2015. DOI: 10.1016/j.jht.2015.03.001
  • Mallet finger: a survey of British Association of Hand Therapists practice. Hand Therapy. 2016. DOI: 10.1177/1758998316664822
  • The mallet finger injury: a review (current concepts in diagnosis and management). Arch Plast Surg. 2016. DOI: 10.5999/aps.2016.43.2.134
  • Outcomes of dorsal splinting for mallet finger. Hand (N Y). 2022. DOI: 10.1177/15589447221093674
  • Conservative splinting versus extension-block K-wiring for bony mallet finger: a randomized controlled trial. J Hand Surg (Eur Vol). 2020. DOI: 10.1177/1753193420917567
  • Tendon avulsion fractures of the distal phalanx (terminal extensor avulsion). Clin Orthop Relat Res. 2006. DOI: 10.1097/01.blo.0000205903.51727.62
  • Tendon ruptures in the hand. Hand Clin. 2012. DOI: 10.1016/j.hcl.2012.05.040
  • Single K-wire fixation of bony mallet finger in non-compliant patients. Arch Orthop Trauma Surg. 2021. DOI: 10.1007/s00402-021-03793-4
  • Subluxation of bony mallet fractures with Stack splint immobilisation. J Hand Surg Am. 2013. DOI: 10.1016/j.jhsa.2013.08.111

Mallet-finger management literature (URLs)

  • Medscape — Mallet Finger Treatment & Management. https://emedicine.medscape.com/article/1242305-treatment
  • StatPearls — Mallet Finger (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK459373/
  • Current concepts in the management of mallet finger (PMC; ~1 mm terminal-tendon lengthening ≈ 25° extensor lag). https://pmc.ncbi.nlm.nih.gov/articles/PMC4022957/
  • Physiopedia — Mallet Finger. https://www.physio-pedia.com/Mallet_Finger

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