Mallet finger, or drop finger, is a deformity of the finger caused by damage to the extensor tendon below the DIP joint, preventing straightening of the fingertip. It most commonly occurs in the long, ring, or small finger of the dominant hand in young males after the fingertip is forcibly bent backwards. Treatment depends on the severity of the injury but generally involves splinting the finger to keep the DIP joint straight as the tendon heals, usually for 6-8 weeks. Surgery may be needed for open injuries, large bone fragments, or if non-surgical treatment is unsuccessful. Complications can include an extensor lag deformity or swan neck deformity if not properly

1. Mallet finger
Dr. Santosh Batajoo

2. Introduction
• Deformity of the finger caused by damaged
extensor tendon distal to DIP.
• Also called baseball finger or hammer finger or
drop finger.
• Disruption may be bony or tendinous.
• Injury at zone 1.

3. • Common in young to middle-aged males and
older females.
• Most frequently involves long, ring and small
fingers of dominant hand.

4. Mechanism
• Ball or the object strikes the tip of the finger or
thumb and forcibly bends it.
• A minor force such as tucking in a bed sheet.
• Force tears the tendon or even pull away a piece
of bone.

5. • Less common mechanism is a sharp or crushing-
type laceration to the dorsal DIP joint.
• Less commonly, a forceful hyperextension injury
of the DIP joint.

6. Classification (Doyle’s)
Type I Closed injury with or without small dorsal avulsion fracture
Type II Open injury (laceration)
Type III Open injury ( deep soft tissue abrasion involving loss skin and
tendon substance)
Type IV Mallet fracture
A- distal phalanx physeal injury (pediatrics)
B- fracture fragment involving 20% to 50% of articular surface
(adult)
C- fracture fragment >50% of articular surface (adult)

7. Signs & symptoms
• The fingertip droops. The patient cannot
straighten but passive movement is normal.
• Finger may be painful, swollen and bruised.
• Lack of active DIP extension.
• Swan-neck deformity

8. Diagnosis
• X-ray : Avulsion of distal phalanx
May be a ligamentous injury with normal
bony anatomy.

9. Treatment
NONSURGICAL:
• Goal – to keep the fingertip straight until the
tendon heals.
• Extension splints with DIP joint in extension for
6-8 weeks then at night for a 4 additional
weeks.
• Bone avulsion – mallet splint for 6 weeks

10. • Maintain free movement of the PIP joint.
• Begin progressive flexion exercise at 6 weeks.

11. Surgical :
Indications-
• volar subluxation of distal phalanx,
• large bone fragments with >50% articular suface
involved,
• non-surgical treatment was not successful.
• >2mm articular gap

12. • CRPP or ORIF – pin fixation or dorsal/extension
blocking pin.
• ORIF with a pull-out wire.
• Surgical reconstruction of terminal tendon in
chronic injury > 12 weeks with healthy joint –
direct repair, tenodermodesis or retinacular
ligament reconstruction
• Central slip release (Fowler)

13. • Type 1 and type 2 can be treated closed.
• Type 3 require soft tissue coverage and pinning
of the DIP joint.
• DIP arthrodesis – painful, stiff, arthritic DIP
joint
• Swan neck deformity – lateral band tenodesis,
FDS tenodisis, Fowler central slip tenotomy

14. Complications
• Extensor lag
• Non union
• Swan neck deformities due to – attenuation of
volar plate and transverse retinacular ligament
at PIP joint, dorsal subluxation of lateral bands,
hyperextension of PIP, contracture of
traiangular ligament.

15. Thank you…