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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 Aug 2026
一幅手绘插图，展示了一只手，其中一个指尖下垂，无法伸直。
锤状指：手指末端下垂，因为伸直末节指骨的伸肌腱撕裂或从其附着点撕脱。 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。

您的感受

您可能会注意到指尖下垂，且无法自行伸直。这是因为负责抬起手指的肌腱受损。疼痛通常位于指尖处。当您尝试活动该部位或按压时，可能会感到尖锐的疼痛。

这种不适感通常在您使用手部后会加重。诸如打字、提重物或进行体育运动等活动会使疼痛加剧。早晨刚醒来时，您可能还会感到僵硬。这种僵硬感通常在活动手部几分钟后缓解。

日常活动变得困难。例如，向后伸手扣内衣可能会很困难。将衬衫塞进裤子里时，需要小心协调，以免牵拉手指。侧卧睡觉时，可能会压迫受伤的指尖，导致疼痛并影响睡眠。

在某些情况下，双手均会受到影响。如果您体内存在某些生化改变，可能会出现这种情况。如果是儿童，损伤可能同时涉及肌腱和一小块骨碎片。这种情况罕见，但可能发生。

大多数情况下，我们通过支具进行治疗。我们在您手指背面粘贴一个简单的支撑装置。这有助于保持指尖伸直，使肌腱得以愈合。您需要连续佩戴数周。仅当大块骨头骨折或骨头移位时，才需要手术。

支具治疗和手术治疗的效果均良好。您可能会经历一些持续的僵硬感，尤其是在治疗前下垂严重的情况下。完全矫正需要时间。请耐心对待您的康复过程。您的外科医生将指导您完成整个过程。

实际发生了什么

您的指尖有一根名为终腱的小肌腱。它附着在手指末节骨上。这根肌腱像一根绳子，负责将您的指尖拉直。当您伸直手指时，这根“绳子”会收紧以抬起指尖。

在锤状指损伤中，这根“绳子”会断裂或从骨头上撕脱。这通常发生在您的伸直指尖突然向内弯曲时。想象一下在伸手拿东西时，指尖被桌边勾住。这种力量超过了肌腱所能承受的范围。

由于这根“绳子”断裂，您失去了自主伸直指尖的能力。关节处于弯曲位置。这被称为锤状畸形。您可能会注意到指尖下垂。但是，如果由他人帮助您活动，您仍然可以完全伸直它。这是因为被动活动范围保持完整。

这种损伤可以通过两种方式发生。首先，肌腱本身可能完全撕裂。其次，一小块骨头可能随肌腱一起撕脱。这被称为撕脱性骨折。骨碎片包括肌腱附着点，因此结果看起来相似。这两种类型都会导致相同的下垂姿势。

有时，大块骨头会断裂。这涉及关节表面的三分之一以上。在这些情况下，末节骨可能会向前滑脱，导致对位不良。这被称为掌侧半脱位。这会改变关节的功能，通常需要不同的治疗。

在儿童中，损伤可能影响生长板而不是肌腱。那里的骨头较软。骨折可能导致指尖向锤状姿势移位。过伸通常有助于将其复位。

大多数锤状指是由闭合性损伤引起的。皮肤保持完整。皮肤破裂的开放性损伤并不常见。小指、无名指和中指最常受影响。这在男性中很常见。

我们能采取的措施

基兰·希尔帕拉（Kieran Hirpara）医生作为麦特私人医院（Mater Private Hospital Rockhampton）的上肢外科医生，其在诊所处理此类问题的方式体现了一条清晰的诊疗路径。患者通过全科医生或物理治疗师的转诊来到我们的诊所。诊所评估（包括病史采集、体格检查以及必要的影像学检查）确立诊断。对于结构性或急性问题，可能会直接建议手术，而无需先进行非手术治疗。对于退行性或长期存在的问题，我们通常先尝试非手术治疗——包括活动调整、物理治疗或手部治疗、夹板固定和注射治疗——并在非手术治疗未能带来足够改善时考虑手术。

大多数锤状指损伤无需手术即可良好愈合。我们通常从背侧胶合夹板或简单夹板开始。佩戴该夹板可使手指末端保持伸直。手部治疗师治疗 1 型锤状指损伤的效果与外科医生相当。他们采用的固定方法在皮肤状况方面几乎没有任何并发症。补充夜间夹板固定在伸肌滞后、功能障碍或对治疗的满意度方面并不能改善预后。部分患者使用另一种简单的定制矫形器。该矫形器允许近端指间关节（PIP）屈曲，同时限制完全伸直或过伸。急性闭合性锤状指的保守治疗管理方法多样，常辅以夹板固定进行锻炼和干预。

偶尔会针对急性或慢性锤状指病例，或既往治疗失败后的补救治疗建议手术。对于非手术治疗失败的急性及慢性锤状指病变患者，我们可能会考虑手术治疗。对于无法在佩戴夹板的情况下工作的患者，我们也考虑手术治疗。当锤状指骨折涉及超过三分之一的关节面时，通常建议手术。对于所有出现远节指骨掌侧半脱位的患者，也建议手术。然而，即使在复杂病例中，手术治疗显著优势尚未得到明确证实。Doyle 4c 型锤状指保守治疗的并发症率低，表明大块骨折病例可以通过保守治疗有效管理。

预期情况

大多数锤状指损伤无需手术即可良好愈合。您可能需要佩戴夹板以保持手指末端伸直。这有助于肌腱或骨骼在正确的位置愈合。对于大多数患者而言，无论是夹板固定还是手术治疗，都能取得良好的临床结果。

如果您的损伤涉及较大的骨碎片或关节发生移位，您的外科医生可能会建议进行手术。这通常是为了稳定关节并防止长期畸形。即使在更复杂的病例中，结果通常也非常好。

您应预期恢复过程需要数月时间。持之以恒是关键。您必须按照外科医生的建议持续佩戴夹板。过早取下夹板可能导致损伤重新裂开或愈合不良。一旦愈合完成，您将逐渐恢复活动度和力量。

部分患者可能会注意到指尖有轻微的僵硬或无法完全伸直的轻微弯曲。这被称为伸肌滞后（extensor lag）。如果损伤严重或治疗延迟，这种情况更为常见。然而，这种轻微的功能受限很少会影响您日常使用手部活动的能力。

并发症并不常见。如果损伤得到适当处理，感染、骨不连（骨骼未能愈合）或指甲畸形都是罕见的。如果骨折涉及关节面的大部分，关节移位的风险会增加。您的外科医生将密切监测这一情况，以确保正确的对位。

在极少数初始治疗失败的情况下，可能需要进一步的手术来矫正畸形。这些补救手术在恢复功能和外观方面是有效的。总体而言，在适当的护理下，您可以期望完全恢复正常活动和爱好。

何时就诊

若休息后疼痛持续不缓解，请咨询全科医生。若发现手指无力或不稳，请要求专科医生评估。若关节出现交锁或无力感，请寻求医疗帮助。若症状干扰睡眠或工作，请联系医生。病情突然加重也是寻求医疗帮助的指征。锤状指损伤有时可表现为双侧受累，即双手均受影响。生化异常也可能在这些损伤中发挥作用。早期评估有助于确定您是否需要简单的固定或进一步治疗。您的外科医生将根据您的具体情况指导最佳后续步骤。

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

  • 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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