Materiały źródłowe

• #1 Current concepts: mallet finger

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4022957/

  Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. […] Injury to the extensor mechanism at the distal interphalangeal (DIP) joint can lead to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger can lead to a swan neck deformity from PIP joint hyper extension and DIP joint flexion.

• #2 Mallet finger | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/mallet-finger?lang=us

  Mallet finger is an injury of the extensor mechanism of the finger at the level of the distal interphalangeal (DIP) joint. It may represent an isolated tendinous injury or occur in combination with an avulsion fracture of the dorsal base of the distal phalanx. […] The DIP joint is extended by combined pulling force of the terminal (lateral bands) of the extensor tendon, functioning together with the oblique retinacular ligament. Injury to these structures commonly results from direct axial or flexion loading of the DIP joint, as can occur by direct blow from a ball. […] The terminal extensor tendon inserts on the DIP joint capsule, and so injurious force may also result in an intra-articular avulsion fracture of the base of the distal phalanx. This may represent an epiphyseal injury in skeletally-immature children.

• #3 Mallet Finger Injuries – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459373/

  Mallet finger is the term usually applied to extensor avulsion fractures. However, this entity may also be caused by distal extensor tendon ruptures. Either one results in an inability to extend the DIP joint. Mallet finger injuries are caused by the disruption of the extensor mechanism of the phalanx at the level of the distal interphalangeal joint, usually due to a forced flexion at the distal interphalangeal joint. This injury results in the inability to extend the distal phalanx. A mallet fracture occurs when the extensor tendon also causes avulsion of the distal phalanx. […] Mallet finger injuries are usually caused by a traumatic event resulting in forced flexion of the extended fingertip. This causes a stretching or tearing of the extensor tendon. In severe injuries, this forced flexion can cause an avulsion of the tendon insertion on the distal phalanx and is described as a mallet fracture. Mallet finger injuries can also be caused by a laceration/abrasion, or more rarely, a forced hyperextension of the distal interphalangeal joint. Such an injury results in a fracture at the dorsal base of the distal phalanx. This disruption of extensor tendon function causes an unopposed flexion force on the finger and is accompanied by the inability to extend the digit. This injury results in the classic mallet appearance of the finger.

• #4

  https://www.orthobullets.com/hand/6014/mallet-finger

  Mallet Finger is a finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint. […] mechanism of injury usually caused by a traumatic impaction blow (i.e. sudden forced flexion) to the tip of the finger in the extended position. […] forces the DIP joint into forced flexion. […] a less common mechanism of injury is a sharp or crushing-type laceration to the dorsal DIP joint.

• #5 Extensor tendon injury of the distal interphalangeal joint (mallet finger) – UpToDate

  https://www.uptodate.com/contents/extensor-tendon-injury-of-the-distal-interphalangeal-joint-mallet-finger

  Extensor tendon injury of the distal interphalangeal joint (mallet finger) […] Mallet finger injuries are sustained through high-velocity or low-velocity trauma. High-velocity injuries most often occur during collision sports (eg, American football, rugby) and ball-handling sports (eg, basketball, baseball, cricket). The injury is usually caused by a direct blow to the tip of the finger, such as when a ball strikes the fingertip or the fingertip strikes a rigid surface. This can cause forceful flexion of the distal interphalangeal (DIP) joint, leading to a tear in the extensor tendon near its insertion on the distal phalanx. A high-velocity axial load may also produce a forceful extension of the DIP joint, causing a bony fracture of the distal phalanx. Lower velocity flexion forces, such as might be involved in changing bed linens, can produce tendinous mallet finger injuries in older adults with weakened tissue. Less frequently, a mallet finger may occur from a dorsal laceration or crushing mechanism.

• #6 Current concepts: mallet finger

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4022957/

  The most common mechanism of injury in mallet finger is a sudden flexion of the DIP joint with the resistance force directed along the long axis of the finger. This leads to terminal extensor tendon tear or tendon avulsion with a bony fragment. In athletes, it is commonly seen with a forceful blow to the tip of the finger causing sudden flexion. […] DIP joint hyperextension can cause mallet finger secondary to a dorsal lip fracture as the hyperextended distal phalanx impacts on the head of the middle phalanx.

• #7 MALLET FINGER – Texas Orthopedic and Spine Associates

  https://txosa.com/mallet-finger/

  Mallet finger occurs when an event injures the tendon that straightens the end of a finger. […] Sudden flexion of the distal interphalangeal (DIP) joint with resistance force directed along the long axis of the finger remains the most commonly known mechanism of injury. […] Furthermore, this sudden flexion and resistance causes avulsion of the tendon with a bony fragment or tear in the terminal extensor. […] Mallet finger secondary to a dorsal lip fracture may result from DIP joint hyperextension when the hyperextended distal phalanx impacts on the head of the middle phalanx. […] In chronic cases, patients may exhibit hyperextension at the proximal interphalangeal joint due to increased extension tone and migration of the extensor apparatus, leading to Swan neck deformity.

• #8

  https://www.orthobullets.com/hand/6014/mallet-finger

  Mallet Finger is a finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint. […] mechanism of injury usually caused by a traumatic impaction blow (i.e. sudden forced flexion) to the tip of the finger in the extended position. […] forces the DIP joint into forced flexion. […] a less common mechanism of injury is a sharp or crushing-type laceration to the dorsal DIP joint.

• #9 Mallet Finger – Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mallet-finger-diagnosis-and-treatment/

  The term mallet finger refers to injury of the extensor tendon of the distal interphalangeal (DIP) joint, resulting in loss of active extension of the DIP joint and a DIP joint that rests at roughly 45° flexion (1,2). […] The mechanism of injury commonly involves a traumatic forced flexion of the distal phalanx when in the extended position (3). A mallet finger can also result from a sharp or crushing laceration to the dorsal DIP joint. […] Diagnosis of mallet finger injuries can be made with physical examination, history, and radiographs (3). […] Patients will typically present with pain in the affected joint, deformity, and an extensor deficit at the DIP joint. There is often a forced flexion or hyperextension injury of the DIP joint (3). […] The goal of treatment is to restore DIP joint extension and prevent a swan neck deformity (1, 3).

• #10

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/hand-distal-phalanges/proximal-dorsal-avulsion/definition

  Discontinuities of the extensor insertion are often referred to as mallet injury or baseball finger. They can be purely tendinous or bony avulsion fractures. […] An avulsion injury destroys the synergistic balance of the pull exerted by the flexor and extensor tendons. The continuity of the flexor tendon is lost. This results in an inability to flex the DIP joint. […] The commonest cause of these injuries is forcible flexion of the actively extended DIP joint, as when stubbing a straight finger against resistance. […] Occasionally, the injury results from an axial overload of the terminal segment of the finger, causing joint impaction and a dorsal marginal fracture, which is retracted by the pull of the extensor tendon. […] An obliquely orientated axial compression force sometimes results in a dorsal marginal fracture, involving approximately half the articular surface, and can disrupt the collateral ligaments. […] In complete disruption of the central part of the extensor mechanism, the patient is unable to actively extend the DIP joint. […] A similar clinical picture is presented by bony avulsion of the extensor mechanism at its insertion. The dorsal avulsion fracture is of variable size.

• #11 Mallet Finger – Connecticut Orthopaedics

  https://www.ct-ortho.com/patient-resources/patient-education/articles/mallet-finger/

  Mallet finger is a condition caused by disruption of the tendon (extensor mechanism) of the finger joint at the base of the fingernail. The tendon that extends the tip of the finger can be disrupted in two ways, either the tendon or the bone where the tendon inserts. If the problem is in the tendon, it is called a tendinous mallet finger. If the problem is caused by a fracture, then it is called a bony mallet fracture. […] The specific difference between a sprain and a mallet finger is the latter is associated with a rupture of the tendon that extends the tip or DIP joint. With the tendon rupture the first thing to happen is that you cannot actively extend the finger. One of the classic findings is the ability to passively extend the joint, but a loss of active extension. […] On the negative side, the treatment is full time splinting, keeping the finger completely straight at the DIP joint but encouraging flexion of the remainder of the finger. This helps maintain flexibility of the other joints.

• #12 Current concepts: mallet finger

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4022957/

  Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. […] Injury to the extensor mechanism at the distal interphalangeal (DIP) joint can lead to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger can lead to a swan neck deformity from PIP joint hyper extension and DIP joint flexion.

• #13 Mallet Finger: Practice Essentials, Anatomy, Etiology

  https://emedicine.medscape.com/article/1242305-overview

  The term mallet finger has long been used to describe the deformity produced by disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint. […] The terminal portion of the extensor mechanism that crosses the DIP joint in the midline dorsally is responsible for active extension of the distal joint. A flexion force on the tip of the extended finger jolts the DIP joint into flexion. This may result in a stretching or tearing of the tendon substance or an avulsion of the tendon’s insertion on the dorsal lip of the distal phalanx base. In either instance, active extension power of the DIP joint is lost, and the joint rests in an abnormally flexed position. […] From experimental studies, the rate of loading determines whether a tendon (or ligament) ruptures in midsubstance or is avulsed from its bony attachment. Rapid loading rates are more likely to cause a tear in the tendon itself, while lower loading rates are more likely to cause a bony avulsion. This is because the bone is relatively more viscoelastic than the tendon. […] With a disruption of the dorsal mechanism at the DIP joint, the entire power of extension is directed to the PIP joint. Over time, and especially if the volar plate is lax, this concentrated extension force results in PIP joint hyperextension and a swan-neck deformity.

• #14 Mallet finger | PPT

  https://www.slideshare.net/slideshow/mallet-finger-40711893/40711893

  Any injury causing a flexion or extension deformity in one IP joint can lead to tendon imbalance, creating an opposite deformity in the adjacent IP joint. At DIP joint: FDP flexion force is counterbalanced by the terminal extensor tendon. At PIP joint: flexion forces of the FDP and FDS tendons are counterbalanced by the extension forces of the conjoined lateral bands and the central slip of extensor apparatus.

• #15 Mallet finger | PPT

  https://www.slideshare.net/slideshow/mallet-finger-40711893/40711893

  Mallet Finger An injury that involves disruption of the extensor mechanism at the level of the distal interphalangeal (DIP) joint. […] Most common mechanism: Sudden forced flexion of the extended fingertip. This results in either: stretching or tearing of extensor tendon substance or avulsion of tendon insertion from the dorsum of distal phalanx, with or without a fragment of bone. […] With a mallet injury, the delicate balance between flexion and extension forces is disrupted. The following sequence of events occurs: Discontinuity of the terminal extensor tendon Migration of extensor apparatus proximally Increased extensor tone at PIP relative to DIP joint. Early or late swan neck deformity (hyperextension of PIP joint with concomitant flexion of DIP joint) can occur. […] Pathoanatomy A well-balanced system exists between intrinsic and extrinsic tendons, and between flexion and extension forces across each finger interphalangeal (IP) joint.

• #16 Mallet Finger | Musculoskeletal Key

  https://musculoskeletalkey.com/mallet-finger-2/

  Mallet finger is an injury to the terminal extensor mechanism at the level of the distal interphalangeal (DIP) joint. This can be caused by either tendon rupture in zone 1 or an avulsion fracture of the distal phalanx with a fragment of bone that remains attached to the tendon. […] There are two proposed mechanisms of injury. […] Traumatic impaction blow (Figure 32.1) the initial step involves an axial force to finger held in extension followed by either one of two steps: […] Extreme passive DIP joint hyperflexion, which results most commonly in a tendinous mallet finger. […] Extreme passive DIP joint hyperextension, which results most commonly in a bony mallet finger. […] Dorsal laceration less common; sharp or crushing laceration to the dorsal DIP joint. […] Mallet fingers comprise approximately 9% of all tendinous/ligamentous lesions with an incidence estimated at 5.6% of all tendinous lesions in the hand. […] With the loss of the terminal extensor tendon insertion, the central slip receives all of the tension; the volar plate and transverse retinacular ligament attenuate; the lateral bands sublux dorsally; and the proximal interphalangeal (PIP) joint may be forced into extension in chronic injuries.

• #17 Internet Scientific Publications

  http://ispub.com/IJOS/3/1/10539

  Mallet finger also called drop or baseball finger is a deformity of the finger caused by detachment of the extensor mechanism from the base of the distal phalanx, either directly or in association with a fracture. […] Warren et al, in their study noted an area of deficient blood supply in the distal digital extensor tendon area and suggested that this zone of avascularity might have implications in the cause and treatment of mallet finger. […] With a disruption of the dorsal mechanism at the DIPJ, the entire power of extension is directed to the PIPJ. Over time, and especially if the volar plate is lax, this concentrated extension force results in PIPJ hyperextension and a swan-neck deformity (the DIPJ rests in an abnormally flexed position and the PIPJ rests in a hyper-extended position). This deformity frequently causes a functional deficit. Therefore, even if a mallet finger is not particularly symptomatic from a functional or cosmetic perspective, treatment of the mallet injury may preclude development of this swan-neck deformity.

• #18 Current concepts: mallet finger

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4022957/

  Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. […] Injury to the extensor mechanism at the distal interphalangeal (DIP) joint can lead to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger can lead to a swan neck deformity from PIP joint hyper extension and DIP joint flexion.

• #19 MALLET FINGER – Texas Orthopedic and Spine Associates

  https://txosa.com/mallet-finger/

  Mallet finger occurs when an event injures the tendon that straightens the end of a finger. […] Sudden flexion of the distal interphalangeal (DIP) joint with resistance force directed along the long axis of the finger remains the most commonly known mechanism of injury. […] Furthermore, this sudden flexion and resistance causes avulsion of the tendon with a bony fragment or tear in the terminal extensor. […] Mallet finger secondary to a dorsal lip fracture may result from DIP joint hyperextension when the hyperextended distal phalanx impacts on the head of the middle phalanx. […] In chronic cases, patients may exhibit hyperextension at the proximal interphalangeal joint due to increased extension tone and migration of the extensor apparatus, leading to Swan neck deformity.

• #20 Mallet Finger: Practice Essentials, Anatomy, Etiology

  https://emedicine.medscape.com/article/1242305-overview

  The term mallet finger has long been used to describe the deformity produced by disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint. […] The terminal portion of the extensor mechanism that crosses the DIP joint in the midline dorsally is responsible for active extension of the distal joint. A flexion force on the tip of the extended finger jolts the DIP joint into flexion. This may result in a stretching or tearing of the tendon substance or an avulsion of the tendon’s insertion on the dorsal lip of the distal phalanx base. In either instance, active extension power of the DIP joint is lost, and the joint rests in an abnormally flexed position. […] From experimental studies, the rate of loading determines whether a tendon (or ligament) ruptures in midsubstance or is avulsed from its bony attachment. Rapid loading rates are more likely to cause a tear in the tendon itself, while lower loading rates are more likely to cause a bony avulsion. This is because the bone is relatively more viscoelastic than the tendon. […] With a disruption of the dorsal mechanism at the DIP joint, the entire power of extension is directed to the PIP joint. Over time, and especially if the volar plate is lax, this concentrated extension force results in PIP joint hyperextension and a swan-neck deformity.

• #21 Sydney Hand Surgery » Mallet Finger

  https://www.sydneyhandsurgeryclinic.com.au/mallet-finger/

  Mallet finger deformities can result from closed or open injuries. The usual mechanism of a closed is a sudden forced flexion of the DIP joint. This typically occurs in various ball sports when the tip of the finger is struck by a ball. Most commonly this causes a traumatic rupture of the extensor tendon as it inserts into the dorsal lip of the base of the distal phalanx. It can also cause distal phalangeal avulsion fractures of various sizes. […] Any laceration or open wound overlying the extensor aspect of the DIP joint can result in a mallet finger. […] Untreated mallet injuries will result in a permanent flexion deformity of the DIP joint with secondary joint degeneration. […] Open injuries require thorough debridement including washout of a likely open joint and an appropriate tendon repair.

• #22 Internet Scientific Publications

  http://ispub.com/IJOS/3/1/10539

  Mallet finger also called drop or baseball finger is a deformity of the finger caused by detachment of the extensor mechanism from the base of the distal phalanx, either directly or in association with a fracture. […] Warren et al, in their study noted an area of deficient blood supply in the distal digital extensor tendon area and suggested that this zone of avascularity might have implications in the cause and treatment of mallet finger. […] With a disruption of the dorsal mechanism at the DIPJ, the entire power of extension is directed to the PIPJ. Over time, and especially if the volar plate is lax, this concentrated extension force results in PIPJ hyperextension and a swan-neck deformity (the DIPJ rests in an abnormally flexed position and the PIPJ rests in a hyper-extended position). This deformity frequently causes a functional deficit. Therefore, even if a mallet finger is not particularly symptomatic from a functional or cosmetic perspective, treatment of the mallet injury may preclude development of this swan-neck deformity.

• #23 Mallet Finger And Other Finger Extensor Injuries – OrthoPaedia

  https://www.orthopaedia.com/mallet-finger-and-other-finger-extensor-injuries/

  Mallet finger is most commonly seen in the small, ring, and middle fingers in the dominant hand. Mallet finger more commonly affects men, usually during work or sports related activities. […] Central slip dysfunction may be related to direct trauma or to a volar dislocation of the PIP joint. The sagittal bands may also be damaged from a direct injury to the MCP joint, as occurs in boxing. The radial sagittal band is most commonly injured leading to ulnar subluxation of the extensor mechanism. […] In the acute setting, a mallet finger is treated with splinting of the DIP joint in full extension for six weeks and occasionally up to three months. Even in the chronic setting extension splinting can be tried. If non-operative treatment is unsuccessful, a primary repair or reconstruction may need to be performed by a hand specialist. If there is subluxation of the DIP joint due to a large bony articular fragment avulsion, primary repair may be the first line of treatment.

• #24 Mallet Finger | Musculoskeletal Key

  https://musculoskeletalkey.com/mallet-finger-2/

  Mallet finger is an injury to the terminal extensor mechanism at the level of the distal interphalangeal (DIP) joint. This can be caused by either tendon rupture in zone 1 or an avulsion fracture of the distal phalanx with a fragment of bone that remains attached to the tendon. […] There are two proposed mechanisms of injury. […] Traumatic impaction blow (Figure 32.1) the initial step involves an axial force to finger held in extension followed by either one of two steps: […] Extreme passive DIP joint hyperflexion, which results most commonly in a tendinous mallet finger. […] Extreme passive DIP joint hyperextension, which results most commonly in a bony mallet finger. […] Dorsal laceration less common; sharp or crushing laceration to the dorsal DIP joint. […] Mallet fingers comprise approximately 9% of all tendinous/ligamentous lesions with an incidence estimated at 5.6% of all tendinous lesions in the hand. […] With the loss of the terminal extensor tendon insertion, the central slip receives all of the tension; the volar plate and transverse retinacular ligament attenuate; the lateral bands sublux dorsally; and the proximal interphalangeal (PIP) joint may be forced into extension in chronic injuries.

• #25 Extensor tendon injury of the distal interphalangeal joint (mallet finger) – UpToDate

  https://www.uptodate.com/contents/extensor-tendon-injury-of-the-distal-interphalangeal-joint-mallet-finger

  Extensor tendon injury of the distal interphalangeal joint (mallet finger) […] Mallet finger injuries are sustained through high-velocity or low-velocity trauma. High-velocity injuries most often occur during collision sports (eg, American football, rugby) and ball-handling sports (eg, basketball, baseball, cricket). The injury is usually caused by a direct blow to the tip of the finger, such as when a ball strikes the fingertip or the fingertip strikes a rigid surface. This can cause forceful flexion of the distal interphalangeal (DIP) joint, leading to a tear in the extensor tendon near its insertion on the distal phalanx. A high-velocity axial load may also produce a forceful extension of the DIP joint, causing a bony fracture of the distal phalanx. Lower velocity flexion forces, such as might be involved in changing bed linens, can produce tendinous mallet finger injuries in older adults with weakened tissue. Less frequently, a mallet finger may occur from a dorsal laceration or crushing mechanism.

• #26 Mallet Finger: A Change in Perspective

  https://bracelab.com/clinicians-classroom/mallet-finger-a-change-in-perspective?srsltid=AfmBOooKuZhFH5_cFMjfbgD0_xciCe7hgLC3ZS3WSiIcbwvg_Xrnx5m4

  Using lateral x-rays to determine the DIP joint position, Giddens found that the extensor lag resulting from a tendinous mallet finger injury is greater than the lag created by a bony mallet injury. […] The fact that tendinous injuries are more commonly seen in older patients with lessened tissue integrity means that the time required for healing in this group is always longer than younger patients who sustain a bony mallet injury. […] Defining the two types of mallet injuries determines our treatment approach. […] A tendinous mallet requires positioning the DIP joint in slight extension for 6-8 weeks to ensure tendinous healing. […] A bony mallet requires immobilization in neutral to slight flexion for 4 to 6 weeks to ensure bony alignment and reduce distal phalanx subluxation. […] Comparing the physical characteristics of the closed bony mallet finger injury versus tendinous mallet finger injury challenges us to think more critically about mallet finger treatment. Consider that all mallet finger injuries are not created equally and therefore should be treated the differently.

• #27 Mallet Finger: A Change in Perspective

  https://bracelab.com/clinicians-classroom/mallet-finger-a-change-in-perspective?srsltid=AfmBOooKuZhFH5_cFMjfbgD0_xciCe7hgLC3ZS3WSiIcbwvg_Xrnx5m4

  Using lateral x-rays to determine the DIP joint position, Giddens found that the extensor lag resulting from a tendinous mallet finger injury is greater than the lag created by a bony mallet injury. […] The fact that tendinous injuries are more commonly seen in older patients with lessened tissue integrity means that the time required for healing in this group is always longer than younger patients who sustain a bony mallet injury. […] Defining the two types of mallet injuries determines our treatment approach. […] A tendinous mallet requires positioning the DIP joint in slight extension for 6-8 weeks to ensure tendinous healing. […] A bony mallet requires immobilization in neutral to slight flexion for 4 to 6 weeks to ensure bony alignment and reduce distal phalanx subluxation. […] Comparing the physical characteristics of the closed bony mallet finger injury versus tendinous mallet finger injury challenges us to think more critically about mallet finger treatment. Consider that all mallet finger injuries are not created equally and therefore should be treated the differently.

• #28 Mallet Finger: A Change in Perspective

  https://bracelab.com/clinicians-classroom/mallet-finger-a-change-in-perspective?srsltid=AfmBOooKuZhFH5_cFMjfbgD0_xciCe7hgLC3ZS3WSiIcbwvg_Xrnx5m4

  Using lateral x-rays to determine the DIP joint position, Giddens found that the extensor lag resulting from a tendinous mallet finger injury is greater than the lag created by a bony mallet injury. […] The fact that tendinous injuries are more commonly seen in older patients with lessened tissue integrity means that the time required for healing in this group is always longer than younger patients who sustain a bony mallet injury. […] Defining the two types of mallet injuries determines our treatment approach. […] A tendinous mallet requires positioning the DIP joint in slight extension for 6-8 weeks to ensure tendinous healing. […] A bony mallet requires immobilization in neutral to slight flexion for 4 to 6 weeks to ensure bony alignment and reduce distal phalanx subluxation. […] Comparing the physical characteristics of the closed bony mallet finger injury versus tendinous mallet finger injury challenges us to think more critically about mallet finger treatment. Consider that all mallet finger injuries are not created equally and therefore should be treated the differently.

• #29 Mallet Finger • LITFL • Trauma Library

  https://litfl.com/mallet-finger/

  Surgery may be required if 30% of the articular surface is avulsed, or if the distal phalanx demonstrates volar subluxation. […] Clinical mallet deformity + no fractures seen on x-ray = tendinous mallet injury. […] Mallet injuries may lead to a chronic swan-neck deformity if treatment is delayed or splintage is inadequate.

• #30 Mallet Finger – Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mallet-finger-diagnosis-and-treatment/

  Most mallet finger injuries can be treated non-surgically. Commonly reported indications for non-surgical treatment include closed injury and a fracture fragment size that is < ⅓ of the joint surface area (1,3). [...] Indications include size of fracture (more than one-third of articular surface involvement) and subluxation of the distal phalanx (1,3). [...] Surgical techniques include trans-DIP joint K-wire fixation, open reduction internal fixation with K-wire, and open suture repair of the tendon plus trans-DIP joint K-wire fixation (1).

• #31 Internet Scientific Publications

  http://ispub.com/IJOS/3/1/10539

  Kalainov et al recently demonstrated that closed and displaced mallet finger fractures with greater then one third articular surface damage could be treated non operatively with negligible pain, patient satisfaction and good function at 2 years follow up. However patients with palmar subluxation of distal phalanx may develop swan neck deformity and extensor lag and degenerative joint changes.

• #32 Mallet Finger: A Change in Perspective

  https://bracelab.com/clinicians-classroom/mallet-finger-a-change-in-perspective?srsltid=AfmBOooKuZhFH5_cFMjfbgD0_xciCe7hgLC3ZS3WSiIcbwvg_Xrnx5m4

  A review of closed bony or tendinous mallet finger treatment reveals the accepted approaches are typically the same: fabricate an orthosis to immobilize the distal interphalangeal (DIP) joint in neutral to slight hyperextension continuously for 6 to 8 weeks. […] A closed bony mallet injury results from a more forceful injury such as a fall, playing sports, or the result of trauma. […] Unlike the tendinous mallet injury, bony mallet injuries often result from a forced hyperextension of the finger DIP joint. […] The resulting fracture of the dorsum of the distal phalanx base may include significant articular involvement. […] The hyperextension DIP joint injury may also rupture the palmar aspect of the DIP joint capsule, which effects joint stability. […] Tendon injuries in the hand take longer to heal than injuries to the bone because the tendon is relatively avascular.

• #33 Mallet Finger: Causes, Symptoms & Treatment | Action Rehab

  https://actionrehab.com.au/mallet-finger-causes-symptoms-treatment/

  When dissecting the mechanism that causes this injury, the most common mechanism of injury in mallet finger is a sudden flexion of the DIP joint with the resistance force directed along the long axis of the finger. This leads to terminal extensor tendon tear or tendon avulsion with a bony fragment. […] Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyperextension and DIP joint flexion. […] Soft-tissue mallets can be quite complex and requires consistent patient compliance to ensure a positive result is meet as little as 1 mm of terminal tendon lengthening resulted in 25 of DIP joint extension lag. This means adjusting exact tension during orthosis making is crucial. Once the extension force by the central slip and lateral bands overcomes the flexion force by the superficial and deep flexor tendon across the proximal interphalangeal joint, a Swan neck deformity is created.

• #34 MALLET FINGER | Hand Surgery Resource

  https://www.handsurgeryresource.net/mallet-finger

  The classic „mallet finger” injury involves the forced flexion of the distal interphalangeal (DIP) joint while the finger is in active extension and results from the disruption in continuity of the extensor tendon over the DIP joint. […] During a mallet finger injury the terminal extensor tendon is torn off the dorsal rim of the base of the distal phalanx. […] There is no agreement on the indications for the surgical treatment of soft tissue mallet finger injuries. Most surgeons recommend splinting while some surgeons feel surgical repair of the soft tissue mallet finger injury can minimize the residual extension lag. […] Surgical repair of the terminal extensor tendon is frequently unsuccessful because of the thin nature of the tendon and shredding of the injured tendon that can cause sutures to pull out.

• #35 How to manage my mallet finger – GC Hand Therapy

  https://gchandtherapy.com/how-to-manage-my-mallet-finger-or-thumb-injury/

  Mallet finger is usually caused by a sudden blow to the tip of your finger (or thumb) that then results in being unable to straighten the tip of your finger. The sudden force to the tip of the finger has caused the tendon to rupture (tendinous mallet injury) or the tendon and a piece of bone has been pulled away (bony mallet injury), resulting in there being no mechanism to pull the finger back straight. […] If you have a mallet finger, it needs to be treated, it will not heal on its own. […] A good understanding of the treatment expectations is very important in the management of a mallet injury as splinting compliance is vital in a good outcome. […] In some cases, surgical intervention may be required if the bone fragment that has been pulled away with the tendon is a large fragment or if there is poor joint alignment. […] If left untreated or through failed conservative management, mallet finger can lead to a swan neck deformity.

Zobacz więcej