MANUAL MINORS
Mallet finger with fracture occurs when there is an injury to the extensor tendon responsible for straightening the fingertip, accompanied by a fracture of the distal phalanx. This injury typically results from direct trauma to the fingertip, causing it to remain in flexion without the ability to straighten. It is common in sports or activities involving contact with balls.
Diagnosis
Diagnosis is based on the clinical history of direct trauma, combined with the inability to extend the distal joint of the affected finger. Physical examination reveals the finger in passive flexion at the distal joint, and X-rays confirm the presence of a fracture at the base of the distal phalanx.
Differential Diagnosis
Condition | Main Characteristics |
|---|---|
Extensor tendon tear | Tendon injury without fracture; the finger remains flexed, but no bone injury is visible on X-rays. |
Distal phalanx fracture | Fracture without tendon involvement, typically caused by a direct blow. |
Mallet finger without fracture | Only the extensor tendon is involved, with no fracture seen on imaging studies. |
Emergency Management
Immediate immobilisation of the finger in extension using a splint or specialised device is essential to prevent movement of the distal joint. Immobilisation must be maintained for at least 6 weeks to allow proper healing of both the tendon and the fracture. Pain management is provided with analgesics.
Definitive Treatment
The definitive treatment depends on the severity of the fracture. Mild cases are managed with continuous splinting. In more severe cases, surgical intervention may be required to fix the fracture and repair the damaged tendon using screws or pins.
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