Mallet Fingers

Evaluation and Management

  1. A mallet finger is usually a closed injury of the extensor tendon at its insertion (zone I).
  2. The finger is in a flexed posture due to the unopposed force of the strong deep flexor.
  3. Request an X-ray: PA & lateral at the level of the DIPJ of the affected joint.
  4. Fit a basic mallet splint and refer.

Stack Splint:

Off the shelf splint, taped with a zinc oxide tape, just distal to the PIPJ Ensure that the DIPJ is well extended in the splint and the PIPJ is free to flex. The patient must be advised NOT to remove the splint under any circumstance and to keep the finger dry at all times.
Patient should be referred to a hand therapist for ongoing management.

Stack Splint

Zimmer Splint

A more commonly available option is to use a zimmer splint (metal bar with foam). Zinc oxide tape is used to secure the zimmer splint dorsally over the DIPJ, with the DIPJ in neutral extension.

Zimmer Splint Thermoplastic dorsal splinting

Thermoplastic dorsal splinting, secured with zinc oxide tape.