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锤状指

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

Updated Oct 2026
一幅手绘插图，展示一只手，其中一个指尖下垂，无法伸直。
锤状指：由于伸直末节指间关节的伸肌腱撕裂或从其附着点撕脱，导致指尖下垂。 Holly Cheng / Wikimedia Commons, CC BY-SA 3.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的症状

锤状指表现为手指最后一个关节下垂，您无法自行将指尖伸直。手指通常仍能正常向下弯曲。这种损伤发生在负责伸直指尖的肌腱被撕脱时，有时还会带走一小块骨片。它常常发生在球击中伸直手指的末端时，这也是它成为常见足球损伤的原因。

疼痛位于最后一个关节的背面，就在指甲下方。通常在受伤后的最初几天最为疼痛，此时手指肿胀，触碰时有压痛。弯曲指尖会加重疼痛。一旦用夹板将手指固定在伸直位，疼痛通常会缓解。下垂本身并不疼，但会改变手指的使用方式。

需要指尖稳定的日常活动会变得不便。捡起小硬币、穿针、转动小钥匙或按按钮都可能变得笨拙，因为指尖无法平直地按压。写字或拿手机的感觉也可能有所不同。手指的中间关节也可能比平时更向后弯，以弥补下垂的指尖。

有些人会注意到，在手整夜静止不动之后，手指早上看起来更糟，开始活动后会变得灵活一些。

有几种警示征兆需要迅速处理。如果您的手指变得发热、发红、肿胀和疼痛，尤其是伴有发烧，请当天前往急诊科。如果受伤关节上方的皮肤破损，或手指看起来明显变形，请当天就医。如果受伤后您的手指变得苍白、冰冷、发白或发青，或者突然失去感觉或无法活动，请当天就医。如果症状没有缓解、在数周内逐渐加重，或使您无法工作或使用手部，请就诊于您的全科医生，或要求专科医生评估。

实际发生了什么

指尖背面有一根细小的腱索，这是一束连接肌肉与骨骼的纤维。它最末端的纤维锚定在指甲正下方的最后一节小指骨上。当您伸直手指时，这根腱索会牵拉这块骨头。在锤状指中，这根腱索已从其锚定点断开。有时它还会连带撕下一小块骨片。

一旦腱索不再附着，就没有任何结构能将指尖向上托起。将指尖向下弯曲的肌肉仍然正常工作，由于没有相反方向的牵拉，它便占了上风。指尖处于下垂状态，您无法自行伸直，但仍可以用另一只手把它推直。这是因为负责弯曲的肌肉完好无损，而负责伸直的腱索已经断开。

这种损伤通常发生在伸直的指尖突然被迫弯曲时，例如伸手时手指被口袋或床单勾住。关节面也可能受累。如果撕脱的骨块占关节面的三分之一以上，或最后一节指骨错位，通常建议手术。较小的骨块通常仅用夹板治疗。

即使治疗顺利，也可能残留一些下垂，大多数人都能较好地适应。如果夹板固定无效，可以选择手术，但手术的优势尚未得到明确证实。

我们如何处理

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会根据您的具体伤情制定治疗方案。有些锤状指无需手术即可愈合，而另一些则需要尽快手术，因此及时评估非常重要。患者通常由全科医生（GP）转诊至我们的诊所；如果物理治疗师建议您就诊，您仍需获得全科医生的转诊，才有资格享受 Medicare 报销。在诊所，我们会采集病史，检查您的手指，并在需要时安排 X 光检查。X 光片可以显示是否有骨块随肌腱一起脱落、骨块有多大，以及手指最后一节指骨是否已经错位。

对于大多数损伤，治疗从使用夹板将指尖固定在伸直位开始。夹板需要连续佩戴 6 至 8 周，因为哪怕只弯曲几分钟（例如洗手时），也可能破坏愈合。我们的手部治疗师、Extend Rehabilitation 的 Ruby Doolan 会为您适配夹板并指导您进行锻炼。手部治疗师治疗这类损伤的效果与外科医生一样好，而且夹板固定很少引起皮肤问题。如果取下夹板后手指仍然下垂，再延长数周夹板固定是治疗计划的一部分，并不意味着治疗失败。在此基础上额外加戴夜间夹板并无额外益处。如果您从事运动，在手指用夹板固定期间，需要避免导致受伤的那项运动。即使是受伤后 2 至 4 周才开始治疗、此前一直被忽视的损伤，夹板固定仍可取得良好效果。

当撕脱的骨块累及关节面的三分之一以上，或手指最后一节指骨已向掌侧错位时，通常建议手术。对于夹板固定后仍持续下垂的情况，或从未治疗过的陈旧性损伤，偶尔也会建议手术。如果夹板固定无效，可以选择手术，但手术的优势尚未得到明确证实。手术将肌腱或骨折块固定在原位，使指尖能够再次伸直；手术有专门的页面介绍。

预期情况

大多数锤状指通过夹板即可恢复。约一半的损伤仅靠夹板固定即可治愈或明显改善。夹板将指尖固定在伸直位 6 至 8 周，肌腱在该位置愈合。如果取下夹板时手指仍然下垂，再延长数周夹板固定是治疗计划的一部分，而不意味着治疗失败。

恢复效果在很大程度上取决于是否严格按照指示佩戴夹板。遵守夹板佩戴要求的人比自行取下夹板的人效果更好。哪怕只弯曲几分钟也可能破坏愈合，这就是夹板需要连续佩戴的原因。在受伤后两周内接受治疗的损伤，很少遗留长期功能障碍。受伤后 2 至 4 周未经治疗的损伤，夹板固定仍可取得良好效果，因此开始治疗较晚并不是放弃治疗的理由。

即使治疗顺利，也可能残留一些下垂。指尖可能无法完全平直，大多数人都能较好地适应这一点。最后一个关节在抓握中承担的作用很小，因此轻微的永久性下垂通常没有看起来那么要紧。如果夹板固定无效，可以选择手术，但手术的优势尚未得到明确证实。

如果完全不加处理，锤状指往往会一直保持下垂。肌腱不会在没有帮助的情况下自行重新附着。有些人带着下垂的手指也能正常生活，而另一些人在数月中会对笨拙的指尖感到困扰。如果您的症状没有缓解、在数周内逐渐加重，或使您无法工作或使用手部，请就诊于您的全科医生，或要求专科医生评估。

何时就医

大多数锤状指是由球击中伸直手指的末端造成的，常见于足球运动。指尖下垂且无法自行伸直，这通常足以促使人们就医。一些较大的骨折表现不同：即使有骨块脱落，指尖仍可能保持伸直，因此指尖受撞击后疼痛持续不缓解的手指，仍然值得拍 X 光片。骨性锤状指损伤通常发生在手指被迫向后弯曲时，而不是向前弯曲时。

有几种征兆需要迅速处理。如果您的手指变得发热、发红、肿胀和疼痛，尤其是伴有发烧，请当天前往急诊科。如果受伤关节上方的皮肤破损，或手指看起来明显变形，请当天就医。如果受伤后您的手指变得苍白、冰冷、发白或发青，或者突然失去感觉或无法活动，请当天就医。如果症状没有缓解、在数周内逐渐加重，或使您无法工作或使用手部，请就诊于您的全科医生，或要求专科医生评估。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您做出自身治疗决策所需的深度。锤状指值得额外阅读，因为通常被视为手术明确指征的两种情况——较大的骨折碎片以及夹板固定后持续存在的下垂——其确立程度并不像其表述所体现的确定性那样明确。

两种治疗均能取得良好效果，且无人知晓分界线何在

一项关于手术与非手术治疗的系统综述得出了一个异常直接的结论：两者均能带来良好的临床结局，且现有证据不足以确定何时应进行手术干预 [1]。

后半部分才是关键所在。争议并非在于哪种治疗有效，而在于选择手术的阈值——即判断骨折块过大或关节半脱位过重的临界点——目前基于惯例而非比较性证据。

当骨折块累及关节面超过三分之一，或远节指骨发生半脱位时，通常建议进行手术治疗，但即使在那些复杂病例中，手术治疗具有显著优势这一观点尚未得到明确证实 [2]。

夹板固定有效，关键在于固定时长

关于矫形器的证据更为具体。三项研究中有两项发现矫形器干预具有较大的效应量，范围从 2.17 到 12.12，建议的固定时间为 6 至 8 周，若存在滞后现象则需额外延长数周 [3]。

由此得出两个实用要点。第一，夹板必须持续保持指尖伸直，肌腱断端仅靠体位保持对合，清洗时哪怕几分钟的屈曲动作都会使计时重新开始。第二，“若存在滞后现象则需额外延长数周”是治疗方案的一部分，而非治疗失败的迹象。

为何残留的屈曲受限通常是可以接受的

治疗后出现轻微的永久性伸指滞后是常见的，通常与正常的手部功能相容。远端关节对抓握的贡献相对较小，大多数人能适应几度的屈曲受限，且在功能上几乎察觉不到。

在权衡是否对不完美结果进行手术时，这一点至关重要，因为对该关节的手术并非没有代价：骨折块较小，皮肤较薄，且对如此小的关节进行克氏针或钢丝固定存在感染、指甲畸形和关节僵硬的风险，这些风险必须与美容至轻度功能改善的收益相权衡。鉴于上述综述无法证明即使在复杂病例中手术也具有优势，接受适度的滞后是一个符合循证医学的选择，而非妥协。

并非锤状指的畸形

锤状指属于闭合性伸肌腱损伤家族中的一员，其主要区别在于腱断裂发生的具体位置：锤状指位于指尖，钮孔状指位于中间关节，而矢状带损伤位于掌指关节 [4]。在早期，由于肿胀掩盖了损伤模式，这些损伤常被相互混淆，且每种损伤所需的夹板固定位置各不相同。若将钮孔状指误当作锤状指进行夹板固定，会固定错误的关节，这正是为何在承诺进行六周制动之前，值得确认诊断的原因。

参考文献

[1] Lin JS, Samora JB. 锤状指的手术与非手术治疗：系统综述. J Hand Surg Am. 2018;43(2):146-163.e2. https://doi.org/10.1016/j.jhsa.2017.10.004

[2] Lamaris GA, Matthew MK. 锤状指损伤的诊断与治疗. Hand (N Y). 2016;12(3):223-8. https://doi.org/10.1177/1558944716642763

[3] Valdes K, Naughton N, Algar L. 锤状指的保守治疗：系统综述. J Hand Ther. 2015;28(3):237-46. https://doi.org/10.1016/j.jht.2015.03.001

[4] Lin JD, Strauch RJ. 闭合性软组织伸肌机制损伤（锤状指、纽扣畸形及矢状带损伤）. J Hand Surg Am. 2014;39(5):1005-11. https://doi.org/10.1016/j.jhsa.2013.11.018

Reviewed by Kieran Hirpara · 27 April 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

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

  • Most mallet finger injuries can be managed non-surgically with splinting [6].
  • Surgery is occasionally recommended for acute or chronic mallet finger cases or for salvage of failed prior treatment [6].
  • Mallet fingers can be cured or significantly improved in approximately 50% of cases by simple splintage [3, 9].
  • After a mallet-finger injury treated within two weeks by either internal or external splintage, few patients have significant persistent disability [8].
  • Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes [7].
  • There was insufficient evidence from randomised controlled trials to establish the relative effectiveness of different custom-made or off-the-shelf finger splints used for treating mallet finger injury [15].
  • The perforated mallet finger splint can produce consistently good results even in patients who would not tolerate a conventional splint [33, 34].
  • Compliant patients have significantly better outcomes than noncompliant patients in the treatment for mallet finger injuries [22].
  • Specialist hand therapists could treat mallet finger by themselves, providing that the patients fit the inclusion criteria for non-operative treatment [17].
  • 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 [1].
  • Absolute indications for surgical intervention for mallet fingers in the pediatric population remain unclear [2].
  • Simple surgery such as Kirschner wire fixation of the DIP joint or tenodermodesis is of benefit in most patients with mallet finger who fail to be cured by simple splintage [11].
  • Delayed surgical management of bony mallet fingers demonstrated adequate functional outcome with minimal complications when compared with prior literature [4].
  • Complication rates were low, suggesting that large-fragment mallet finger cases can be effectively managed conservatively [5].
  • 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 [46].
  • A significant advantage of surgical management even in complicated mallet fracture cases has yet to be clearly proven [46].
  • The role of surgery for mallet fractures of the thumb remains unclear due to their uncommon nature and favorable radiographic findings [18].
  • Primary surgical repair is the preferred treatment for mallet thumb, but conservative treatment should be the first choice if there is no skin wound or the conditions at first consultation are not appropriate for surgery [32].
  • Central slip tenotomy is the best choice for mallet finger deformity because of the minimal amount of time required to return to function [14].
  • The authors recommend the central slip release as an alternative to reconstruction in certain types of chronic mallet finger deformity [24].
  • A safe and simple technique for chronic mallet fingers is proposed if deformity exceeds 30°, for patients untreated after the second month, or when splinting has failed [13].
  • Today most authorities splint only the distal joint for mallet finger deformities [10].

Anatomy & Pathophysiology

Anatomy

  • The extensor apparatus of the fingers includes the interosseous muscle, extensor digitorum communis tendon, lumbrical muscle, flexor tendon sheath, sagittal bands, transverse metacarpal ligament, interosseous hood, interosseous hood oblique fibers, extensor lateral band, extensor middle band, interosseous middle band, interosseous lateral band, oblique retinacular ligament, central extensor lateral, spiral fibers, transverse retinacular ligament, lateral extensor tendon, triangular lamina, and terminal extensor tendon [27].
  • The terminal extensor tendon inserts onto the distal phalanx [27].
  • The mallet finger deformity reflects the loss of normal extensor force transmission via the terminal tendon insertion onto the distal phalanx [41].
  • The unopposed flexor digitorum profundus pulls the distal joint into flexion in mallet finger deformity [41].
  • Displacement of the epiphysis of the distal phalanx can cause the digit to assume a mallet finger posture [27].
  • Hyperextension of the phalanx usually affords satisfactory reduction of a displaced epiphysis in mallet finger [27].

Pathophysiology

  • Mallet finger involves loss of continuity of the extensor tendon over the distal interphalangeal joint [28].
  • Mallet finger results in a flexion deformity of the distal finger joint [28].
  • Mallet finger may lead to an imbalance between flexion and extension forces more proximally in the digit [28].
  • The mallet finger deformity is characterized by a loss of active distal interphalangeal joint extension with full passive range of motion evident [41].
  • The usual mechanism of injury involves sudden passive flexion of the actively extended distal interphalangeal joint [41].
  • 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 [41].
  • Because the avulsed fragment includes the terminal tendon insertion, the clinical appearance of soft tissue and bony mallet fingers is similar [41].
  • The distal joint rests in flexion, a posture that cannot be actively changed in mallet finger [41].
  • Full passive extension of the distal interphalangeal joint is possible in mallet finger [41].
  • Mallet finger is due to a disruption of the extensor mechanism from its insertion at the dorsal base of the distal phalanx [57].
  • Closed mallet injuries are usually from a sudden forced flexion of a previously extended distal interphalangeal joint [57].
  • Mallet finger most commonly involves a closed rupture of the terminal tendon with or without associated fracture of the distal phalanx [91].
  • Snagging the extending finger on a pants cuff, a bedsheet, or other object that suddenly flexes the extending distal interphalangeal joint is a frequent cause of mallet finger [91].
  • A forceful hyperextension injury of the distal interphalangeal joint may result in a large fracture of the base of the distal phalanx involving one-third or more of the articular surface [91].
  • Elderly patients with osteoarthritis of the distal interphalangeal joint may have mallet deformities that are not related to trauma [91].
  • Individuals with hyperlax joints may have multiple pseudomallet swan neck postures that are unrelated to trauma [91].
  • Open mallet injuries are uncommon [91].
  • The most frequently involved digits in mallet finger are the small, ring, and middle fingers of the dominant hand [91].
  • Mallet finger has a male predominance [91].
  • Tendinous mallet fingers have been reported to occur from age 11 onward [91].
  • In skeletally immature individuals, a transepiphyseal plate fracture may be seen in mallet finger [91].
  • There may be a familial predisposition to mallet fingers [91].
  • An epidemiologic survey of 24 members of a three-generation family revealed an unusually high incidence of mallet fingers [12].
  • Twenty mallet fingers were found in seven family members by clinical examination, suggesting a familial predisposition to develop this deformity [12].
  • Multiple mallet fingers occurred in the surveyed family, with a range of two to six per member [12].
  • The term "mallet finger" refers to a disruption to the terminal extensor mechanism with a lack of full or active extension through the distal interphalangeal joint [53].
  • The term "mallet finger" is a misnomer, as rarely do these digits actually resemble a mallet [53].
  • Other descriptions for mallet finger injuries include "baseball finger," "cricket finger," and "drop finger" [53].
  • The direction of force on the fingertip that results in a mallet fracture has yet to be determined [115].
  • The precise mechanism of injury leading to different sizes of mallet fracture fragments might be difficult to delineate due to multiple variables, including tendon tension at the time of injury and the strain-rate-dependent mechanical properties of the affected bone and soft tissues [115].
  • Distal interphalangeal joint subluxation is expected with a mallet fracture fragment involving more than one-half of the joint surface [115].
  • The distal interphalangeal joint has a remarkable ability to remodel [115].

Classification

  • The Doyle classification system describes four types of mallet finger injuries [119].
  • In the Doyle classification, Type IV represents mallet fractures and is further broken into three subtypes according to the size of articular involvement [119].
  • The Wehbe and Schneider classification describes DIP joint subluxation and epiphyseal and physeal injuries [119].
  • In the Wehbe and Schneider classification, articular injuries are subdivided into type A (less than one-third), type B (between one-third and two-thirds), and type C (larger than two-thirds of the joint) [119].
  • The Doyle classification is proposed to be modified to make it more encompassing and less prone to interobserver error [53].
  • The modified Mallet classification demonstrated strong to excellent agreement and interrater reliability across face-to-face, live tele-assessment, and video-based conditions [113].
  • The modified Mallet classification is suggested to be appropriate for remote medical follow-up [113].
  • 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 [102].
  • There is a need for better randomized, prospective studies to separate the various types of mallet injuries and their treatments [31].

Clinical Presentation

  • Mallet injuries can be classified into four types based on skin integrity and the presence or absence of bony involvement [28].
  • The diagnosis of bony mallet finger is usually straightforward based on the patient’s history, typical findings observed on physical examination (i.e., drop finger deformity and lack of DIPJ extension) and identification of an avulsion fracture on lateral finger radiographs [66].
  • Mallet finger is often associated with a dorsal fracture of the base of the terminal phalanx [67].
  • In cases of mallet finger with fracture, the avulsed fragment is typically small [67].
  • In cases of mallet finger with fracture, there may be hyperextension at the proximal interphalangeal joint [67].
  • In some cases of dorsal basal fracture, the fragment is appreciably larger and widely separated but there is no dropping of the fingertip [67].
  • In cases with a larger dorsal basal fragment and no dropping of the fingertip, there is no associated hyperextension at the proximal interphalangeal joint [67].
  • In cases with a larger dorsal basal fragment and no dropping of the fingertip, there may be volar subluxation of the terminal phalanx [67].
  • Bony mallet injuries are typically caused by hyperextension rather than hyperflexion [44].
  • Mallet finger injuries are frequent in football [43].
  • Mallet deformity accounts for a minority of sporting injuries [36].
  • Multiple mallet fingers occurred in the surveyed family, with a range of two to six per individual [12].

Investigations

  • A radiograph should be obtained to determine whether a fracture is present [41].
  • If a fracture is present, a radiograph should determine whether the dorsal fragment is large and whether the distal phalanx is subluxed palmarward [41].
  • The clinical appearance of soft tissue and bony mallet fingers is similar, with the distal joint resting in a flexion posture that cannot be actively changed [41].
  • Full passive extension of the distal interphalangeal joint is possible in mallet finger deformities [41].

Treatment

Non-Operative Management

  • Splinting of the distal interphalangeal joint for 6 to 8 weeks has yielded good results while minimizing morbidity in the majority of patients [28].
  • 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 [30].
  • This study supports the rationale for nonsurgical treatment of closed and displaced mallet finger fractures with greater than one-third articular surface involvement [39].
  • The author argues that mallet fractures can be treated by nonoperative methods, stating that nonoperative treatment provided good results without the need for manipulation, open or closed, and without the use of pins [99].
  • 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 [38].
  • 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 [86].
  • A hand therapist can treat type 1 mallet finger injuries as effectively as a surgeon [97].
  • The management of uncomplicated mallet fingers by the hand therapy team achieved satisfactory results, indicating that specialist hand therapists could treat mallet finger by themselves, providing that the patients fit the inclusion criteria for non-operative treatment [17].
  • Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment [52].
  • 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].
  • Conservative therapeutic management of acute, closed mallet finger is diverse and varied, with exercises and interventions supplementary to splinting commonly utilised [82].
  • 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 [36].
  • Two patients with closed mallet deformities of the thumb were treated conservatively with satisfactory results [19].
  • The prevailing opinion of most authors is to treat a closed mallet thumb injury nonsurgically with splinting [111].
  • A retrospective study examined the outcomes of acute bony mallet injuries treated with 4 weeks of static immobilization in a splint, followed by graduated mobilization [44].
  • The clinical efficacy of the proposed method of elastic taping for the treatment of mallet finger injuries remains to be tested vigorously [76].
  • The study recommends a simple splint as an alternative means of treating mallet finger [23].

Operative Management

  • Surgery is occasionally recommended for acute or chronic cases or for salvage of failed prior treatment [6].
  • It is concluded that simple surgery such as Kirschner wire fixation of the DIP joint or tenodermodesis is of benefit in most patients with mallet finger who fail to be cured by simple splintage [11].
  • 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 [46].
  • The indications for surgical treatment of bony mallet injuries include dorsal fracture fragments of more than one-third of the joint surface on the lateral radiograph or volar subluxation of the main remainder of the distal phalanx [109].
  • It is a challenging surgery performed in treatment of bony mallet finger [16].
  • We propose this safe and simple technique for chronic mallet fingers if deformity exceeds 30°, for patients untreated (after the second month), or when splinting has failed [13].
  • The method is a suitable alternative in patients with annoying chronic mallet finger who refuse arthrodesis or further conservative treatment [45].
  • The method is simple and very effective for treatment of chronic mallet deformity [50].
  • This method seems to be a new reliable alternative in the treatment of chronic mallet finger [55].
  • Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective [89].

Complications

  • The complication rate after operative treatment of mallet fracture was 41% [117].
  • The high complication rate after operative treatment of mallet fracture is likely attributable to anatomical factors such as thin extensor tendon and poor blood supply [117].
  • Delayed surgical management of bony mallet fingers demonstrated minimal complications when compared with prior literature [4].
  • Complication rates were low in large-fragment mallet finger cases managed conservatively [5].
  • Conservative management of tendinous mallet finger injuries neglected for 2 to 4 weeks is associated with low long-term complication rates [38].
  • A series of acute combined tendon and bone mallet fingers treated with pullout wire fixation and Kirschner wire stabilization reported no complications such as infection, nonunion, or nail deformity [59].

Recovery

Non-Operative Management

  • Treatment by splintage produces a cure or improvement in half the patients studied [9].
  • Most authorities splint only the distal joint for mallet finger deformities [10].
  • The management of uncomplicated mallet fingers by a hand therapy team achieved satisfactory results, indicating that specialist hand therapists could treat mallet finger by themselves provided patients fit inclusion criteria for non-operative treatment [17].
  • 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 [38].
  • Nonsurgical treatment is supported for closed and displaced mallet finger fractures with greater than one-third articular surface involvement [39].
  • Large-fragment mallet finger cases can be effectively managed conservatively with low complication rates [5].

Operative Management

  • The chronic mallet deformity was corrected in each of the 12 cases reported in a series using oblique retinacular ligament reconstruction [25].
  • Tenodermodesis is a useful surgical procedure in cases of mallet fingers where conservative treatment has failed [49].
  • Mallet finger injuries are frequent in football and difficult to treat during the competitive season, often requiring delayed treatment or internal splinting [43].

Key Evidence

  • [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. [1] (10.5999/aps.2016.43.2.134)
  • [L4] Absolute indications for surgical intervention for mallet fingers in this population remain unclear. [2] (10.1016/j.jhsa.2018.03.037)
  • [L1] Mallet fingers can be cured or significantly improved in approximately 50% of cases by simple splintage. [3] (10.1016/0266-7681(88)90124-6)
  • [L4] Delayed surgical management of bony mallet fingers demonstrated adequate functional outcome with minimal complications when compared with prior literature. [4] (10.1177/1558944719840749)
  • [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)
  • [L4] Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes. [7] (10.1016/j.jhsa.2017.10.004)
  • [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)
  • [L1] Our study shows that treatment by splintage is worthwhile in cases of mallet finger, producing a cure or improvement in half the patients studied. [9] (10.1016/0266-7681_88_90124-6)
  • [L5] Today most authorities splint only the distal joint for mallet finger deformities. [10] (10.1016/s0749-0712(21)00059-7)
  • [L4] It is concluded that simple surgery such as Kirschner wire fixation of the DIP joint or tenodermodesis is of benefit in most patients with mallet finger who fail to be cured by simple splintage. [11] (10.1016/0266-7681(88)90127-1)
  • [L4] [12] (10.1016/s0363-5023(88)80003-0)
  • [L4] We propose this safe and simple technique for chronic mallet fingers if deformity exceeds 30°, for patients untreated (after the second month), or when splinting has failed. [13] (10.1016/s1297-3203(02)00008-2)
  • [L4] Central slip tenotomy is the best choice for mallet finger deformity because of the minimal amount of time required to return to function. [14] (10.1016/s0363-5023(87)80205-8)
  • [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] It is a challenging surgery performed in treatment of bony mallet finger. [16] (10.1177/1753193414553139)
  • [L3] The management of these uncomplicated mallet fingers by the hand therapy team achieved satisfactory results, indicating that specialist hand therapists could treat mallet finger by themselves, providing that the patients fit the inclusion criteria for non-operative treatment. [17] (10.1016/s0266-7681(03)00220-1)
  • [L3] The role of surgery for mallet fractures of the thumb remains unclear due to their uncommon nature and favorable radiographic findings. [18] (10.1177/1558944716672192)
  • [L4] Two patients with closed mallet deformities of the thumb were treated conservatively with satisfactory results. [19] (10.1016/s0363-5023(86)80058-2)
  • [L4] Compliant patients have significantly better outcomes than noncompliant patients in the treatment for mallet finger injuries. [22] (10.1016/s0894-1130(12)80037-8)
  • [L2] The study recommends this splint as an alternative means of treating mallet finger. [23] (10.1136/emj.10.3.244)
  • [L4] The authors recommend the central slip release as an alternative to reconstruction in certain types of chronic mallet finger deformity. [24] (10.1016/s0363-5023(78)80042-2)
  • [L4] The chronic mallet deformity was corrected in each of the 12 cases reported in this series. [25] (10.1016/s0363-5023(84)80231-2)
  • [L5] [28] (10.5435/00124635-200509000-00007)
  • [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. [30] (10.1177/1753193421992986)
  • [L4] Primary surgical repair is the preferred treatment for mallet thumb, but conservative treatment should be the first choice if there is no skin wound or the conditions at first consultation are not appropriate for surgery. [32] (10.1016/s0363-5023(86)80057-0)
  • [L1] The perforated mallet finger splint can produce consistently good results even in those patients who would not tolerate a conventional splint. [33] (10.1016/0266-7681(86)90276-7)
  • [L1] The perforated mallet finger splint can produce consistently good results even in those patients who would not tolerate a conventional splint. [34] (10.1016/0266-7681_86_90276-7)
  • [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. [36] (10.1054/jhsb.2000.0484)
  • [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. [38] (10.1016/j.jhsa.2014.06.140)
  • [L4] This study supports the rationale for nonsurgical treatment of closed and displaced mallet finger fractures with greater than one-third articular surface involvement. [39] (10.1016/j.jhsa.2005.02.010)
  • [L5] Mallet finger injuries are frequent in football and difficult to treat during the competitive season, often requiring delayed treatment or internal splinting. [43] (10.1016/j.hcl.2012.05.043)
  • [L4] [44] (10.1177/17531934251382017)
  • [L4] The method is a suitable alternative in patients with annoying chronic mallet finger who refuse arthrodesis or further conservative treatment. [45] (10.1016/0266-7681(89)90102-2)
  • [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. [46] (10.1177/1558944716642763)
  • [L4] Tenodermodesis is a useful surgical procedure in cases of mallet fingers where conservative treatment has failed. [49] (10.1016/s0363-5023(77)80095-6)
  • [L5] The method is simple and very effective for treatment of chronic mallet deformity. [50] (10.1097/00130911-200403000-00006)
  • [L1] Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment. [52] (10.1007/s11552-013-9600-z)
  • [L4] [53] (10.1016/j.jhsa.2022.10.013)
  • [Paper] This method seems to be a new reliable alternative in the treatment of chronic mallet finger. [55] (10.1016/j.injury.2013.01.013)
  • [L3] [57] (10.1016/0363-5023(94)90200-3)
  • [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. [59] (10.1016/j.jhsa.2014.11.011)
  • [L4] [66] (10.1016/j.hansur.2020.08.008)
  • [L4] [67] (10.1016/0020-1383(81)90167-4)
  • [L4] The clinical efficacy of the proposed method of elastic taping for the treatment of mallet finger injuries remains to be tested vigorously. [76] (10.1016/j.jht.2014.02.005)
  • [L4] Conservative therapeutic management of acute, closed mallet finger is diverse and varied, with exercises and interventions supplementary to splinting commonly utilised. [82] (10.1177/1758998316664822)
  • [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. [86] (10.1177/175899830501000103)
  • [L4] Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective. [89] (10.1186/s13018-019-1106-0)
  • [L4] A hand therapist can treat type 1 mallet finger injuries as effectively as a surgeon. [97] (10.1197/j.jht.2008.04.002)
  • [L5] The author argues that mallet fractures can be treated by nonoperative methods, stating that nonoperative treatment provided good results without the need for manipulation, open or closed, and without the use of pins. [99] (10.1016/j.jhsa.2005.01.011)
  • [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. [102] (10.1016/j.jhsa.2024.03.012)
  • [L3] [109] (10.1177/1753193415581517)
  • [L5] [111] (10.1016/j.jhsa.2013.02.001)
  • [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. [113] (10.1177/17531934231196118)
  • [L5] [115] (10.1016/j.jhsa.2008.04.014)
  • [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. [117] (10.1054/jhsb.2000.0440)
  • [L5] [119] (10.1177/1753193414554772)

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e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

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.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.