FINGER

INJURY
Dr. M. Sak2 SpOT

MALLET FINGER
- Mallet nger is disrup2on of the terminal
extensor tendon to the distal phalanx
- May be doe to direct trauma but more oKen
follows tendon rupture when the nger 2p is
forcibly bent during ac2ve extension
- The terminal joint is held exed and the pa2ent
cannot straighten it but passive movement is
normal. With the extensor mechanism
unbalance, the proximal interphalangeal joint
may become hyperextended
- Synonyms: Drop nger; Baseball nger

Ouch!!! <BLEEP>!! ... <BLEEP> !!!

hZp://radiographics.rsnajnls.org/cgi/content-nw/full/24/4/1009

hZp://www.hughston.com/hha/b_16_4_2a.jpg

/F2

Mallet Finger
1

Mechanism of Injury
Flexion force or axial loading
during DIP extension.
Terminal extensor tendon
avulsion.

Presenta2on

Exam Decit
Ac2ve Extension (Extensor
Lag).

Imaging
AP, lateral, oblique.

DIP Flexion +/- edema.

hZp://books.elsevier.com/bookscat/samples/9780323033862/Chapter_15_Common_Finger_Sprains_and_Deformi2es.pdf

hZp://www.eorthopod.com/images/ContentImages/hand/nger_mallet/nger_mallet_diagnosis01.jpg

1. hZp://books.elsevier.com/bookscat/samples/9780323033862/Chapter_15_Common_Finger_Sprains_and_Deformi2es.pdf

Mallet Finger

http://www.eorthopod.com/images/ContentImages/hand/finger_mallet/finger_mallet_intro01.jpg

ANATOMY

DIAGNOSIS
Signs and Symptoms
- The DIP joint of the involved nger is held in
exion, and ac2ve extension is lost; full passive
extension usually is present.
- Hyperextension of the PIP joint also may be
observed.
Physical Exam
- Document the integrity of the skin and nail bed.
- Note ac2ve and passive extension (and exion if
not acute).
- Observe the status of the proximal joints.
- Diagnosis is based on physical examina2on with
radiographs to assess for fracture.

TYPES OF MALLET FINGER

T here are three types
1. a tendinous avulsion
2. a small ake of bone
3. a large dorsal bone fragment, some2mes
with subluxa2on of the joint

TREATMENT
- Full-2me splin2ng of the DIP joint for 6 weeks,
followed by 6 weeks of night splin2ng
- Ar2cular fractures involving less than 25 percent
of the joint and without subluxa2on are treated
the same way as a tendonous mallet nger
- Large ar2cular fragments or joint subluxa2on are
treated with ORIF for displaced dorsal base
fractures comprising >25% of ar2cular surface
- This posi2on is held con2nuously for 6-8 weeks
- An acut mallet nger should be splinted with
joint in extension for 8 weeks

TREATMENT

SUBUNGUAL HEMATOMA
A subungual hematoma is a collec2on of
blood underneath a toenail or ngernail
(collec2on of blood in the space between the
nailbed and nail).

E/ology
Most commonly form aKer a crush-type injury to
the 2p of the nger or toe.
This injury can occur in many ways:
Hinng your nger with a hammer
Dropping a heavy object on your toe
Closing your nger in a door

Occur over 2me from pressure over 2me

(wearing shoes that are too small while prac2cing
or compe2ng).

Symptoms
A discolora2on of red, maroon, or other dark
color beneath the nail aKer an injury.
The most common symptom is intense pain.
Pressure generated between the nail and the nailbed,
where the blood collects, causes this pain.
The pain may also be caused by other injuries such as
a fracture to the underlying bone, or bruising to the
nger or toe itself.

Medical Treatment
Subungual hematomas are treated by either releasing
the pressure by drilling a hole through the nail into the
hematoma (trephining) or by removing the en2re nail.
Removal of the nail is typically done when the nail
itself is disrupted, a large lacera2on requiring suturing
is suspected, or there is a fracture of the 2p of the
nger.
Frequently, the nger or toe is numbed with a digital
block.

A numbing medica2on such as lidocaine is injected at the

boZom of the nger or toe.

The process of burning a hole in the nail to

relieve the hematoma. No2ce the blood
draining from the hole aKer the hole was
formed with the cautery unit's hot 2p. The
nger has been numbed prior to this
procedure.

Needle: A large diameter needle is used to drill or

bore into the nail to create a hole to allow the
blood to drain out.
Paper clip: This technique, although an older one,
is s2ll used by some prac22oners. A paper clip is
opened so that the pointed end is free. Then the
pointed end is heated up, usually by passing it
through a ame, and used to burn through the
nail. This technique uses a combina2on of the
cautery method and the needle method.

 AKer the nail has been drained, soak the nger

or toe in iodine solu2on for 10 minutes.
Cover the area with a sterile dressing and apply
a protec2ve splint for 24-48 hours.
Check carefully for signs of infec2on (including
redness, pain, heat, and drainage from the
wound).

Follow-up
AKer the draining, follow-up is usually not
necessary.
If there was a fracture an2bio2cs.
If the nail was removed and a cut in the nailbed
was s2tched closed re-examina2on in 48-72
hours.
Usually, the type of sutures (s2tches) placed will
dissolve, so removal is not needed.
If nondissolvable sutures (nylon) are placed in a
nailbed lacera2on removed in about 7 days.
Close monitoring is s2ll recommended