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Ngón tay búa

Mallet finger causes fingertip drooping after extensor tendon injury; splinting is key, surgery occasionally needed.

Updated Aug 2026
Một minh họa vẽ tay của một bàn tay với một đầu ngón tay bị rủ xuống, không thể duỗi thẳng.
Ngón tay búa: đầu ngón tay bị chùng xuống do gân duỗi khớp cuối cùng bị rách hoặc bong khỏi điểm bám. Holly Cheng / Wikimedia Commons, CC BY-SA 3.0

Trang này được dịch bằng máy và chưa được bác sĩ kiểm tra. Bản tiếng Anh là bản chính thức.

Những gì bạn đang cảm nhận

Bạn có thể nhận thấy đầu ngón tay của mình bị chùng xuống và không thể duỗi thẳng một cách tự nhiên. Điều này xảy ra do gân nâng ngón tay của bạn bị tổn thương. Cơn đau thường nằm ngay tại đầu ngón tay. Cảm giác đau có thể nhói khi bạn cố gắng cử động hoặc ấn vào vùng đó.

Sự khó chịu thường trở nên nghiêm trọng hơn sau khi bạn sử dụng tay. Các hoạt động như đánh máy, nâng đồ tạp hóa hoặc chơi thể thao có thể khiến cơn đau nhức tăng lên. Bạn cũng có thể cảm thấy cứng khớp khi vừa thức dậy vào buổi sáng. Sự cứng khớp này thường giảm bớt sau khi bạn cử động tay trong vài phút.

Các hoạt động hàng ngày trở nên khó khăn. Việc với tay ra sau lưng để cài móc áo ngực có thể trở nên khó khăn. Việc nhét áo vào quần đòi hỏi sự phối hợp cẩn thận để tránh làm tổn thương ngón tay. Ngủ nghiêng có thể gây áp lực lên đầu ngón tay bị tổn thương, dẫn đến cơn đau khiến bạn khó ngủ.

Trong một số trường hợp, cả hai tay đều bị ảnh hưởng. Điều này có thể xảy ra nếu bạn có những thay đổi sinh hóa nhất định trong cơ thể. Nếu bạn là trẻ em, chấn thương có thể liên quan đến cả gân và một mảnh xương nhỏ. Điều này hiếm gặp nhưng vẫn có thể xảy ra.

Hầu hết thời gian, chúng tôi điều trị tình trạng này bằng nẹp. Chúng tôi dán một giá đỡ đơn giản vào mặt sau của ngón tay của bạn. Điều này giữ cho đầu ngón tay thẳng để gân có thể lành lại. Bạn phải đeo nẹp liên tục trong vài tuần. Phẫu thuật chỉ được thực hiện nếu một mảnh xương lớn bị gãy hoặc nếu xương bị lệch khỏi vị trí.

Cả nẹp và phẫu thuật đều mang lại kết quả tốt. Bạn nên mong đợi một số độ cứng dai dẳng, đặc biệt nếu tình trạng chùng xuống nghiêm trọng trước khi điều trị. Việc sửa chữa hoàn toàn mất thời gian. Hãy kiên nhẫn với quá trình hồi phục của bạn. Bác sĩ phẫu thuật của bạn sẽ hướng dẫn bạn qua quá trình này.

Những gì thực sự đang xảy ra

Đầu ngón tay của bạn có một gân nhỏ gọi là gân tận cùng. Gân này bám vào xương ở đầu cùng của ngón tay. Gân này hoạt động như một sợi dây kéo cho đầu ngón tay duỗi thẳng. Khi bạn duỗi ngón tay, sợi dây này căng ra để nâng phần đầu ngón tay lên.

Trong chấn thương ngón tay búa, sợi dây này bị đứt hoặc tách khỏi xương. Điều này thường xảy ra khi đầu ngón tay đang duỗi thẳng bị gập đột ngột vào trong. Hãy tưởng tượng bạn bị vướng ngón tay vào mép bàn khi với tay lấy thứ gì đó. Lực tác động quá lớn khiến gân không thể chịu đựng được.

Vì sợi dây bị đứt, bạn mất khả năng tự duỗi thẳng đầu ngón tay. Khớp ở vị trí gập. Đây được gọi là biến dạng ngón tay búa. Bạn có thể nhận thấy đầu ngón tay bị rủ xuống. Tuy nhiên, bạn vẫn có thể duỗi thẳng hoàn toàn nếu người khác di chuyển nó giúp bạn. Điều này là do tầm vận động thụ động vẫn còn nguyên vẹn.

Chấn thương có thể xảy ra theo hai cách. Thứ nhất, bản thân gân có thể bị rách hoàn toàn. Thứ hai, một mảnh xương nhỏ có thể bị kéo theo cùng với gân. Đây được gọi là gãy xương do tách mỏm. Mảnh xương bao gồm điểm bám của gân, vì vậy kết quả trông tương tự. Cả hai loại đều gây ra tư thế rủ xuống giống nhau.

Đôi khi, một mảnh xương lớn bị vỡ. Điều này liên quan đến hơn một phần ba bề mặt khớp. Trong những trường hợp này, xương đầu có thể trượt về phía trước và lệch khớp. Đây được gọi là trật khớp lòng bàn tay. Nó làm thay đổi cách hoạt động của khớp và thường đòi hỏi phương pháp điều trị khác.

Ở trẻ em, chấn thương có thể ảnh hưởng đến đĩa tăng trưởng thay vì gân. Xương ở đó mềm hơn. Một vết gãy có thể làm lệch đầu ngón tay thành tư thế ngón tay búa. Duỗi quá mức thường giúp đưa nó trở lại vị trí.

Hầu hết các trường hợp ngón tay búa là do chấn thương kín. Da vẫn nguyên vẹn. Các chấn thương hở, nơi da bị rách, là không phổ biến. Các ngón tay trỏ, giữa và áp út thường bị ảnh hưởng nhất. Điều này phổ biến ở nam giới.

Những gì chúng tôi có thể làm về vấn đề này

Cách tiếp cận của Bác sĩ Kieran Hirpara, một bác sĩ phẫu thuật chi trên tại Bệnh viện Tư nhân Mater Rockhampton, trong phòng khám của chúng tôi phản ánh một lộ trình rõ ràng. Bệnh nhân đến phòng khám của chúng tôi qua giới thiệu của bác sĩ đa khoa hoặc chuyên viên vật lý trị liệu. Đánh giá tại phòng khám (lịch sử bệnh, khám lâm sàng và chẩn đoán hình ảnh khi cần thiết) giúp xác định chẩn đoán. Đối với các vấn đề cấu trúc hoặc cấp tính, phẫu thuật có thể được khuyến nghị ngay lập tức, mà không cần thử nghiệm điều trị không phẫu thuật trước đó. Đối với các vấn đề thoái hóa hoặc kéo dài, chúng tôi thường thử điều trị không phẫu thuật — thay đổi hoạt động, vật lý trị liệu hoặc trị liệu tay, nẹp cố định và tiêm — và xem xét phẫu thuật khi những biện pháp này không mang lại sự cải thiện đủ mức.

Hầu hết các chấn thương ngón tay búa (mallet finger) đều lành tốt mà không cần phẫu thuật. Chúng tôi thường bắt đầu bằng một chiếc nẹp dán mặt lưng hoặc một chiếc nẹp đơn giản. Bệnh nhân đeo nẹp này để giữ thẳng đầu ngón tay. Chuyên viên trị liệu tay có thể điều trị các chấn thương ngón tay búa loại 1 hiệu quả tương đương với bác sĩ phẫu thuật. Họ sử dụng một phương pháp bất động mang lại hầu như không có biến chứng nào liên quan đến tình trạng da. Việc đeo nẹp bổ sung vào ban đêm không cải thiện kết quả về độ trễ duỗi (extensor lag), mức độ tàn tật hoặc sự hài lòng với điều trị. Một số bệnh nhân sử dụng một loại chỉnh hình đơn giản và tùy chỉnh thay thế. Loại chỉnh hình này cho phép gập khớp PIP trong khi hạn chế duỗi hoàn toàn hoặc duỗi quá mức. Quản lý điều trị bảo tồn đối với chấn thương ngón tay búa cấp tính, kín rất đa dạng và phong phú, với các bài tập và can thiệp bổ sung cho việc nẹp cố định thường được sử dụng.

Phẫu thuật đôi khi được khuyến nghị cho các trường hợp ngón tay búa cấp tính hoặc mạn tính, hoặc để xử lý các trường hợp thất bại của điều trị trước đó. Chúng tôi có thể xem xét quản lý phẫu thuật cho các tổn thương ngón tay búa cấp tính và mạn tính ở những bệnh nhân đã thất bại trong điều trị không phẫu thuật. Chúng tôi cũng xem xét phẫu thuật cho những bệnh nhân không thể làm việc khi đang đeo nẹp. Phẫu thuật thường được chỉ định trong trường hợp gãy ngón tay búa liên quan đến hơn một phần ba bề mặt khớp. Phẫu thuật cũng được chỉ định ở tất cả bệnh nhân phát hiện bị trật lòng bàn (volar subluxation) của đốt ngón tay xa. Tuy nhiên, một lợi thế đáng kể của quản lý phẫu thuật ngay cả trong các trường hợp phức tạp vẫn chưa được chứng minh rõ ràng. Tỷ lệ biến chứng đối với quản lý bảo tồn ngón tay búa loại 4c Doyle là thấp, gợi ý rằng các trường hợp mảnh vỡ lớn có thể được quản lý hiệu quả bằng phương pháp bảo tồn.

Những điều cần biết

Hầu hết các chấn thương ngón tay búa (mallet finger) đều hồi phục tốt mà không cần phẫu thuật. Bạn sẽ phải đeo nẹp để giữ thẳng đầu ngón tay. Điều này cho phép gân hoặc xương lành lại ở đúng vị trí. Cả việc đeo nẹp và phẫu thuật đều mang lại kết quả lâm sàng xuất sắc cho đa số bệnh nhân.

Nếu chấn thương của bạn liên quan đến một mảnh xương lớn hoặc khớp bị lệch vị trí, bác sĩ phẫu thuật có thể khuyến nghị phẫu thuật. Thủ thuật này thường được thực hiện để ổn định khớp và ngăn ngừa biến dạng lâu dài. Ngay cả trong những trường hợp phức tạp hơn này, kết quả điều trị nhìn chung vẫn rất tốt.

Bạn nên dự kiến quá trình hồi phục sẽ kéo dài vài tháng. Sự kiên trì là yếu tố then chốt. Bạn phải đeo nẹp liên tục trong suốt thời gian do bác sĩ phẫu thuật chỉ định. Tháo nẹp sớm có thể khiến chấn thương tái phát hoặc lành lại không đúng cách. Khi quá trình lành bệnh hoàn tất, bạn sẽ dần dần khôi phục khả năng vận động và sức mạnh.

Một số bệnh nhân có thể nhận thấy một chút cứng khớp hoặc một độ cong nhẹ ở đầu ngón tay không thể duỗi thẳng hoàn toàn. Tình trạng này được gọi là lag duỗi (extensor lag). Nó phổ biến hơn nếu chấn thương nghiêm trọng hoặc việc điều trị bị trì hoãn. Tuy nhiên, hạn chế nhỏ này hiếm khi ảnh hưởng đến khả năng sử dụng tay cho các công việc hàng ngày của bạn.

Các biến chứng là không phổ biến. Nhiễm trùng, không liền xương (xương không lành lại) hoặc biến dạng móng tay là hiếm khi chấn thương được quản lý đúng cách. Nếu bạn có một gãy xương liên quan đến một phần lớn bề mặt khớp, có nguy cơ khớp bị lệch. Bác sĩ phẫu thuật sẽ theo dõi sát tình trạng này để đảm bảo sự căn chỉnh đúng cách.

Trong những trường hợp hiếm hoi mà điều trị ban đầu thất bại, có thể cần phẫu thuật thêm để sửa chữa biến dạng. Các thủ thuật cứu vãn này có hiệu quả trong việc khôi phục chức năng và thẩm mỹ. Nhìn chung, với sự chăm sóc thích hợp, bạn có thể mong đợi việc trở lại hoàn toàn các hoạt động và sở thích bình thường của mình.

Khi nào cần gặp bác sĩ

Hãy gặp bác sĩ đa khoa nếu bạn có tình trạng đau dai dẳng không cải thiện khi nghỉ ngơi. Hãy yêu cầu được bác sĩ chuyên khoa khám lại nếu bạn nhận thấy yếu hoặc mất vững ở ngón tay. Hãy tìm kiếm sự chăm sóc y tế nếu khớp bị khóa hoặc đột ngột mất vững. Hãy liên hệ với bác sĩ nếu các triệu chứng ảnh hưởng đến giấc ngủ hoặc công việc của bạn. Tình trạng bệnh xấu đi đột ngột cũng là lý do để bạn tìm kiếm sự giúp đỡ. Các chấn thương ngón tay búa (mallet finger) đôi khi có thể xuất hiện ở cả hai bên, nghĩa là cả hai bàn tay đều bị ảnh hưởng. Các bất thường về sinh hóa cũng có thể đóng vai trò trong các chấn thương này. Việc đánh giá sớm giúp xác định xem bạn có cần bất động đơn giản hay cần các phương pháp điều trị khác hay không. Bác sĩ phẫu thuật của bạn sẽ hướng dẫn bạn về các bước tiếp theo tốt nhất cho tình trạng cụ thể của bạn.


Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Absolute indications for surgical intervention for mallet fingers in pediatric populations remain unclear [1].
  • Delayed surgical management of bony mallet fingers demonstrated adequate functional outcomes with minimal complications compared with prior literature [2].
  • Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes [3].
  • Most authorities splint only the distal joint for mallet finger deformities [4].
  • Complication rates for large-fragment mallet finger cases are low, suggesting they can be effectively managed conservatively [5].
  • Most mallet finger injuries can be managed non-surgically with splinting, although surgery is occasionally recommended for acute or chronic cases or for salvage of failed prior treatment [6].
  • The role of surgery for mallet fractures of the thumb remains unclear due to their uncommon nature and favorable radiographic findings [7].
  • After a mallet-finger injury treated within two weeks by either splinting method, few patients have significant persistent disability [8].
  • Some authors propose treating all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which is treated with extra-articular pinning [9].
  • The conservative treatment of mallet finger with a simple splint is recommended as an alternative means of treatment [14].
  • There was insufficient evidence from comparisons tested within randomised controlled trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury [15].
  • Surgery is generally indicated in the case of mallet fractures involving more than one-third of the articular surface as well as in all patients who develop volar subluxation of the distal phalanx [16].
  • A significant advantage of surgical management even in complicated cases (fractures >1/3 articular surface or volar subluxation) has yet to be clearly proven [16].

Anatomy & Pathophysiology

  • The mallet finger deformity is characterized by a loss of active distal interphalangeal (DIP) joint extension with full passive range of motion evident [18].
  • The deformity reflects the loss of normal extensor force transmission via the terminal tendon insertion onto the distal phalanx [18].
  • The unopposed flexor digitorum profundus pulls the distal joint into flexion [18].
  • The usual mechanism of injury involves sudden passive flexion of an actively extended DIP joint [18].
  • Disruption of the terminal tendon may be entirely confined to the tendon or may involve an avulsed fracture fragment from the dorsal lip of the distal phalanx proximal articular surface [18].
  • The clinical appearance of soft tissue and bony mallet fingers is similar because the avulsed fragment includes the terminal tendon insertion [18].
  • The distal joint rests in flexion, a posture that cannot be actively changed [18].
  • Full passive extension of the DIP joint is possible [18].
  • Mallet finger most commonly involves a closed rupture of the terminal tendon with or without associated fracture of the distal phalanx [34].
  • Snagging the extending finger on an object that suddenly flexes the DIP joint is a frequent cause of injury [34].
  • Less commonly, a forceful hyperextension injury of the DIP joint may result in a large fracture of the base of the distal phalanx involving one-third or more of the articular surface [34].
  • Elderly patients with osteoarthritis of the DIP joint may have mallet deformities that are not related to trauma [34].
  • Individuals with hyperlax joints may have multiple pseudomallet swan neck postures that are unrelated to trauma [34].
  • Open mallet injuries are uncommon [34].
  • The most frequently involved digits are the small, ring, and middle fingers of the dominant hand [34].
  • There is a male predominance in mallet finger incidence [34].
  • Tendinous mallet fingers have been reported to occur from age 11 onward [34].
  • In skeletally immature individuals, a transepiphyseal plate fracture may be seen [34].
  • There may be a familial predisposition to mallet fingers [34].
  • The terminal tendon is the primary structure responsible for extending the DIP joint [46].
  • Adjacent retinacular structures provide stability to the DIP joint [46].
  • Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured [47].
  • A mallet finger caused by avulsion of the extensor tendon from the distal phalanx can be satisfactorily treated by splinting 12 weeks after injury [13].
  • Prolonged splinting and splinting longer than 12 weeks may be successful, though the duration may be limited by the patient’s tolerance [13].
  • After 12 weeks, if the distal phalanx droops severely but passive extension in the DIP joint is still satisfactory, surgery may be indicated depending on patient needs [13].
  • Displacement of the epiphysis of the distal phalanx can cause the digit to assume a mallet finger posture [13].
  • Hyperextension of the phalanx usually affords satisfactory reduction of a displaced epiphysis [13].

Classification

  • Most mallet finger injuries can be managed non-surgically with splinting [6].
  • Surgery is occasionally recommended for acute or chronic cases of mallet finger [6].
  • Surgery is occasionally recommended for salvage of failed prior treatment of mallet finger [6].
  • The authors propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger [9].
  • Stage IV mallet finger is treated with extra-articular pinning [9].
  • A modification to the Doyle classification is proposed to make it more encompassing and less prone to interobserver error [31].
  • The interrater reliability of the Kellgren & Lawrence classification system for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed [36].
  • The interrater reliability of the OARSI classification system for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed [36].
  • The modified Mallet classification demonstrated strong to excellent agreement and interrater reliability across face-to-face, live tele-assessment, and video-based conditions [37].
  • The modified Mallet classification is appropriate for remote medical follow-up [37].
  • Non-operative management of mallet fractures is safe regardless of fracture classification [38].
  • Non-operative management of mallet fractures is safe regardless of joint congruence [38].
  • Non-operative management of mallet fractures is safe regardless of pre-existing degenerate change in the DIP joint [38].

Clinical Presentation

  • Mallet finger injuries are frequent in football [19].
  • Mallet deformity accounts for a minority of sporting injuries [28].
  • Bilateral mallet fingers raise questions regarding the possible role of biochemical abnormalities in causing the condition [20].
  • Approximately 50% of patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx do not progress to subluxation of the distal interphalangeal (DIP) joint [21].
  • Fracture size is an independent risk factor for the development of DIP joint subluxation in mallet fracture [21].
  • Time to application of a finger immobilizer is an independent risk factor for the development of DIP joint subluxation in mallet fracture [21].
  • Conservative management of tendinous mallet finger injuries neglected for 2 to 4 weeks can be treated as well as those presenting within the first 2 weeks of injury, with low long-term complication rates [12].
  • Surgery is occasionally recommended for acute or chronic cases of mallet finger or for salvage of failed prior treatment [6].
  • Uncomplicated cases of mallet injuries are best treated by splinting therapy [29].
  • Cases that do not react to splinting therapy are best treated by surgical interventions [29].
  • The authors propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which is treated with extra-articular pinning [9].
  • Early recognition of mallet finger injuries and referrals to a hand surgeon are crucial to avoid long-term disability [11].

Investigations

  • Most authorities recommend splinting only the distal joint for mallet finger deformities [4].
  • A radiograph should be obtained to determine whether a fracture is present [18].
  • Radiographs should be evaluated to assess if the dorsal fragment is large and whether the distal phalanx is subluxed palmarward [18].
  • Approximately 50% of patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx do not progress to subluxation of the DIP joint [21].
  • Fracture size and time to application of finger immobilizer are independent risk factors for the development of DIP joint subluxation in mallet fracture [21].
  • Surgery is generally indicated in cases of mallet fractures involving more than one-third of the articular surface [16].
  • Surgery is generally indicated in all patients who develop volar subluxation of the distal phalanx [16].
  • The advantage of surgical management for complicated cases (large fractures or subluxation) has yet to be clearly proven [16].

Treatment

Non-Operative Management

  • Surgery is occasionally recommended for acute or chronic cases or for salvage of failed prior treatment [6].
  • Conservative management of tendinous mallet finger injuries neglected for 2 to 4 weeks can be treated as well as those presenting within the first 2 weeks, with low long-term complication rates [12].
  • A simple splint is recommended as an alternative means of treating mallet finger [14].
  • There was insufficient evidence from randomized controlled trials to establish the relative effectiveness of different custom-made or off-the-shelf finger splints for treating mallet finger injury [15].
  • Supplemental night splinting does not improve outcomes in terms of extensor lag, disability, or satisfaction with treatment [22].
  • A hand therapist can treat type 1 mallet finger injuries as effectively as a surgeon [24].
  • A hand therapist can treat type 1 mallet finger injuries as effectively as a surgeon, using an immobilization method that offers practically no complications regarding skin condition [32].
  • Hand therapists implement a diverse range of clinical skills to optimize outcome success [23].
  • The clinical efficacy of elastic taping for the treatment of mallet finger injuries remains to be tested vigorously [27].

Operative Management

  • A significant advantage of surgical management over conservative management in complicated cases (fracture >1/3 articular surface or volar subluxation) has yet to be clearly proven [16].
  • Surgical management may be considered for acute and chronic mallet lesions in patients who have failed nonsurgical treatment [30].
  • Surgical management may be considered for acute and chronic mallet lesions in patients unable to work with the splint in position [30].
  • Surgical management may be considered for acute and chronic mallet lesions in patients with a fracture involving more than one third of the joint surface [30].
  • A deepithelialised pedicled skin flap technique is a new reliable alternative in the treatment of chronic mallet finger [25].
  • Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective [33].

Surgical Technique Details

  • A mallet finger caused by avulsion of the extensor tendon from the distal phalanx can be satisfactorily treated by splinting 12 weeks after injury, as described for an acute injury [13].
  • Prolonged splinting and splinting longer than 12 weeks may be successful, though duration may be limited by patient tolerance [13].
  • After 12 weeks, if the distal phalanx droops severely but passive extension in the distal interphalangeal joint is still satisfactory, surgery may be indicated depending on patient needs [13].
  • For surgical repair of chronic mallet finger, make a small V-shaped or U-shaped incision, convex distally, with the tip no closer than 5 mm proximal to the nail base on the dorsum of the finger [13].
  • Avoid injury to the germinal matrix of the nail during incision for chronic mallet finger repair [13].
  • Develop the flap gently in the plane between the tendon and subcutaneous fat, elevating proximally to expose the extensor tendon with intervening scar [13].
  • Attempt to identify the junction of normal tendon with scar and sever the tendon transversely proximal to the joint, leaving the insertion of the tendon into bone [13].
  • Resect sufficient scar or tendon to allow closure of the gap with the finger in maximal extension [13].
  • Support and protect the repair by immobilizing the joint with a transarticular 0.045-inch Kirschner wire [13].
  • Repair the extensor tendon with 4-0 monofilament nylon or 4-0 monofilament wire as a pull-out roll stitch [13].
  • No additional sutures are required for the tendon repair in chronic mallet finger surgery [13].
  • Close the skin with interrupted 5-0 nylon or use 4-0 nylon as a dermotondermal suture [13].
  • Maintain the finger in extension and apply a compressive dressing post-operatively [13].
  • Support the finger with a volar splint for post-operative comfort and to avoid reinjury in the recovery period [13].
  • Sutures are removed at 10 to 14 days post-operatively [13].
  • The distal joint is maintained in extension, with the Kirschner wire protected by a small metal splint, for 4 weeks post-operatively [13].
  • The Kirschner wire is removed after 4 to 6 weeks post-operatively [13].
  • The repair is protected with a splint for 8 weeks post-operatively [13].
  • Normal activities are progressively resumed after the post-operative protocol [13].

Complications

  • Delayed surgical management of bony mallet fingers demonstrated minimal complications [2].
  • Conservative management of neglected tendinous mallet finger injuries (2 to 4 weeks) is associated with low long-term complication rates [12].
  • Large-fragment mallet finger cases managed conservatively have low complication rates [5].
  • Surgical treatment of acute combined tendon and bone (double level) mallet finger injuries reported no complications such as infection, nonunion, or nail deformity [17].
  • The complication rate after operative treatment of mallet fracture was 41% [41].
  • The high complication rate in operative treatment of mallet fracture is likely attributable to anatomical factors such as thin extensor tendon and poor blood supply [41].

Recovery

  • Delayed surgical management of bony mallet fingers demonstrates adequate functional outcomes with minimal complications compared with prior literature [2].
  • Large-fragment mallet finger cases can be effectively managed conservatively with low complication rates [5].
  • All cases of mallet finger are proposed to be treated with a dorsal glued splint except for stage IV mallet finger, which is treated with extra-articular pinning [9].
  • Early recognition of tendon rupture injuries and referrals to a hand surgeon are crucial to avoid long-term disability [11].
  • Surgical treatment of acute combined tendon and bone (double level) mallet finger injuries using pullout wire fixation with distal interphalangeal joint Kirschner wire stabilization reports good to excellent long-term results with no reported complications such as infection, nonunion, or nail deformity [17].
  • Mallet finger injuries are frequent in football and difficult to treat during the competitive season, often requiring delayed treatment or internal splinting [19].
  • Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment [22].
  • The Fowler procedure is the safest and most effective reconstructive measure for chronic mallet finger deformity after phalangeal fracture, offering less morbidity than osteotomy or procedures restraining proximal interphalangeal joint extension [44].

Key Evidence

  • [L4] Absolute indications for surgical intervention for mallet fingers in this population remain unclear. [1] (10.1016/j.jhsa.2018.03.037)
  • [L4] Delayed surgical management of bony mallet fingers demonstrated adequate functional outcome with minimal complications when compared with prior literature. [2] (10.1177/1558944719840749)
  • [L4] Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes. [3] (10.1016/j.jhsa.2017.10.004)
  • [L5] Today most authorities splint only the distal joint for mallet finger deformities. [4] (10.1016/s0749-0712(21)00059-7)
  • [L4] Complication rates were low, suggesting that large-fragment mallet finger cases can be effectively managed conservatively. [5] (10.1186/s12891-026-09787-w)
  • [L5] Most mallet finger injuries can be managed non-surgically with splinting, although surgery is occasionally recommended for acute or chronic cases or for salvage of failed prior treatment. [6] (10.1007/s11552-014-9609-y)
  • [L3] The role of surgery for mallet fractures of the thumb remains unclear due to their uncommon nature and favorable radiographic findings. [7] (10.1177/1558944716672192)
  • [L1] After a mallet-finger injury treated within two weeks by either method few patients have significant persistent disability. [8] (10.1016/s0072-968x(82)80011-9)
  • [L5] The authors propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which they treat with extra-articular pinning. [9] (10.5999/aps.2016.43.2.134)
  • [L4] Early recognition of these injuries and referrals to a hand surgeon for treatment are crucial to avoid longterm disability. [11] (10.1016/j.hcl.2012.05.042)
  • [L3] Conservative management of tendinous mallet finger injuries that have been neglected for 2 to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates. [12] (10.1016/j.jhsa.2014.06.140)
  • [L2] The study recommends this splint as an alternative means of treating mallet finger. [14] (10.1136/emj.10.3.244)
  • [L1] There was insufficient evidence from comparisons tested within randomised controlled trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury. [15] (10.1002/14651858.cd004574.pub2)
  • [L4] Although surgery is generally indicated in the case of mallet fractures involving more than one-third of the articular surface as well as in all patients who develop volar subluxation of the distal phalanx, a significant advantage of surgical management even in those complicated cases has yet to be clearly proven. [16] (10.1177/1558944716642763)
  • [L4] The study describes a surgical technique for acute combined tendon and bone mallet fingers and reports good to excellent long-term results with no reported complications such as infection, nonunion, or nail deformity in the series. [17] (10.1016/j.jhsa.2014.11.011)
  • [L5] Mallet finger injuries are frequent in football and difficult to treat during the competitive season, often requiring delayed treatment or internal splinting. [19] (10.1016/j.hcl.2012.05.043)
  • [L4] This case raises a question regarding the possible role of biochemical abnormalities causing mallet fingers. [20] (10.1177/175899830400900103)
  • [L2] Approximately 50% of patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx do not progress to subluxation of the DIP joint; fracture size and time to application of finger immobilizer are independent risk factors for the development of DIP joint subluxation in mallet fracture. [21] (10.1177/1753193414554556)
  • [L1] Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment. [22] (10.1007/s11552-013-9600-z)
  • [L4] Hand therapists implement a diverse range of clinical skills to optimise outcome success. [23] (10.1177/1758998316664822)
  • [L4] A hand therapist can treat type 1 mallet finger injuries as effectively as a surgeon. [24] (10.1197/j.jht.2008.04.002)
  • [Paper] This method seems to be a new reliable alternative in the treatment of chronic mallet finger. [25] (10.1016/j.injury.2013.01.013)
  • [L4] The clinical efficacy of the proposed method of elastic taping for the treatment of mallet finger injuries remains to be tested vigorously. [27] (10.1016/j.jht.2014.02.005)
  • [L4] Mallet deformity accounts for a minority of sporting injuries, but excellent functional outcome can be achieved with splintage and avoidance of the causative sport while splinted. [28] (10.1054/jhsb.2000.0484)
  • [L4] Uncomplicated cases of mallet injuries are best treated by splinting therapy; cases that do not react to splinting therapy are best treated by surgical interventions. [29] (10.1097/prs.0b013e3181ef8ec8)
  • [L5] Surgical management may be considered for acute and chronic mallet lesions in patients who have failed nonsurgical treatment, are unable to work with the splint in position, or have a fracture involving more than one third of the joint surface. [30] (10.5435/00124635-200509000-00007)
  • [L4] This article provides a topical review of the contemporary literature concerning acute mallet finger injuries and proposes a modification to the Doyle classification to make it more encompassing and less prone to interobserver error. [31] (10.1016/j.jhsa.2022.10.013)
  • [L4] A hand therapist can treat mallet finger injuries of type 1 as effectively as a surgeon, with a method of immobilisation that offers practically no complications regarding skin condition. [32] (10.1177/175899830501000103)
  • [L4] Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective. [33] (10.1186/s13018-019-1106-0)
  • [L4] The interrater reliability of the Kellgren & Lawrence and OARSI classification systems for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed. [36] (10.1016/j.jhsa.2024.03.012)
  • [L3] The modified Mallet classification demonstrated strong to excellent agreement and interrater reliability across face-to-face, live tele-assessment, and video-based conditions, suggesting it is appropriate for remote medical follow-up. [37] (10.1177/17531934231196118)
  • [L3] Non-operative management of mallet fractures, regardless of fracture classification, joint congruence or pre-existing degenerate change in the DIP joint, is safe and yields predictably good outcomes in most patients. [38] (10.1177/1753193421992986)
  • [L4] The complication rate after operative treatment of mallet fracture was 41%, likely attributable to anatomical factors such as thin extensor tendon and poor blood supply. [41] (10.1054/jhsb.2000.0440)
  • [Case_report] The Fowler procedure was the safest and most effective reconstructive measure for this chronic mallet finger deformity, offering less morbidity than osteotomy or procedures restraining proximal interphalangeal joint extension. [44] (10.2106/00004623-197759040-00019)
  • [L5] The TT is the primary structure responsible for extending the distal interphalangeal (DIP) joint, while adjacent retinacular structures provide stability. [46] (10.1016/j.jhsa.2004.04.022)
  • [L5] Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured. [47] (10.1016/j.jhsa.2007.09.006)

References

[1] Outcomes of Splinting in Pediatric Mallet Finger. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.03.037

[2] Delayed Extension Block Pinning in 27 Patients With Mallet Fracture. HAND. 2019. DOI: 10.1177/1558944719840749

[3] Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.004

[4] EXTENSOR TENDON INJURIES AT THE DISTAL INTERPHALANGEAL JOINT. Hand Clinics. 1995. DOI: 10.1016/s0749-0712(21)00059-7

[5] Surgical versus conservative management of Doyle type 4c mallet finger: a comparative study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09787-w

[6] Current Concepts: Mallet Finger. HAND. 2014. DOI: 10.1007/s11552-014-9609-y

[7] Mallet Fractures of the Thumb Compared With Mallet Fractures of the Fingers. HAND. 2016. DOI: 10.1177/1558944716672192

[8] Mallet-Finger Injuries: A Prospective, Controlled Trial of Internal and External Splintage.. Hand. 1982. DOI: 10.1016/s0072-968x(82)80011-9

[9] Review of Acute Traumatic Closed Mallet Finger Injuries in Adults. Archives of Plastic Surgery. 2016. DOI: 10.5999/aps.2016.43.2.134

[11] Tendon Ruptures: Mallet, FDP and ECRB Tendon Ruptures Associated with Lunotriquetral Coalitions in Professional Basketball Players. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.042

[12] Soft-Tissue Mallet Injuries: A Comparison of Early and Delayed Treatment. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.140

[13] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTION OF FINGER FLEXORS: SINGLE-STAGE TENDON GRAFT > CHRONIC MALLET FINGER (SECONDARY REPAIR).

[14] The conservative treatment of mallet finger with a simple splint: a case report.. Emergency Medicine Journal. 1993. DOI: 10.1136/emj.10.3.244

[15] Interventions for treating mallet finger injuries. Cochrane Database of Systematic Reviews. 2004. DOI: 10.1002/14651858.cd004574.pub2

[16] The Diagnosis and Management of Mallet Finger Injuries. HAND. 2016. DOI: 10.1177/1558944716642763

[17] Pullout Wire Fixation Together With Distal Interphalangeal Joint Kirschner Wire Stabilization for Acute Combined Tendon and Bone (Double Level) Mallet Finger Injury. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.11.011

[18] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > 3. Mallet Finger.

[19] Tendon Ruptures: Mallet, FDP in Football. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.043

[20] Bilateral Mallet Fingers: A Case Study. The British Journal of Hand Therapy. 2004. DOI: 10.1177/175899830400900103

[21] The risk factors associated with subluxation of the distal interphalangeal joint in mallet fracture. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414554556

[22] A Prospective Randomized Controlled Trial Comparing Night Splinting with No Splinting after Treatment of Mallet Finger. HAND. 2014. DOI: 10.1007/s11552-013-9600-z

[23] How do hand therapists conservatively manage acute, closed mallet finger? A survey of members of the British Association of Hand Therapists. Hand Therapy. 2016. DOI: 10.1177/1758998316664822

[24] Hand Therapist-led Management of Mallet Finger. Journal of Hand Therapy. 2008. DOI: 10.1197/j.jht.2008.04.002

[25] A new surgical treatment for mallet finger deformity: Deepithelialised pedicled skin flap technique. Injury. 2013. DOI: 10.1016/j.injury.2013.01.013

[27] A novel way of treating mallet finger injuries. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2014.02.005

[28] Mallet Deformity in Sport. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0484

[29] Treatment Options for Mallet Finger: A Review. Plastic and Reconstructive Surgery. 2010. DOI: 10.1097/prs.0b013e3181ef8ec8

[30] Mallet Finger. Journal of the American Academy of Orthopaedic Surgeons. 2005. DOI: 10.5435/00124635-200509000-00007

[31] Acute Mallet Finger Injuries—A Review. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.10.013

[32] Hand Therapist-led Management of Mallet Finger. The British Journal of Hand Therapy. 2005. DOI: 10.1177/175899830501000103

[33] Scar overlapping suture for treating chronic tendinous mallet finger in children. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1106-0

[34] Green S Operative Hand Surgery. CASE STUDY 5.2 Unusual Mallet Finger Presentation.

[36] Rater Agreement of Post-Traumatic Osteoarthritis of the Distal Interphalangeal Joint 12 Years After a Mallet Finger Fracture. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.012

[37] Interrater reliability of face-to-face, tele- and video-based assessments with the modified Mallet classification in brachial plexus birth injuries. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231196118

[38] The non-operative management of bony mallet injuries. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193421992986

[41] Complications of Operative Treatment for Mallet Fractures of the Distal Phalanx. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0440

[44] Mallet deformity of a finger after phalangeal fracture. Case report of treatment by the Fowler procedure. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759040-00019

[46] The terminal tendon of the digital extensor mechanism: Part I, anatomic study. The Journal of Hand Surgery. 2004. DOI: 10.1016/j.jhsa.2004.04.022

[47] A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.09.006

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2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.


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