Tendon Injuries

Objective: To provide primary care physicians with an evidence-based approach to recognizing and managing mallet finger injuries.

Sources of information: A literature search was conducted in PubMed and Google Scholar using relevant key words and subject headings. Recommendations were categorized based on clinical evidence and expert opinion using a 3-level classification system.

Main message: A mallet finger injury commonly occurs after an axial load, resulting in avulsion of the extensor tendon from the distal phalanx. This may occur with or without an avulsion fracture. Diagnosis is made clinically, with x-ray scans used to assess for an associated fracture and joint alignment. Nonsurgical management with continuous splinting for 6 to 8 weeks is the standard of care and achieves excellent outcomes even in cases of delayed presentation. Surgery referral may be considered for avulsion fractures resulting in joint subluxation, open injuries, and failure of conservative management. Untreated mallet finger injuries can lead to chronic swan-neck deformities, which may limit function.

Conclusion: Mallet finger injuries may be easily recognized and managed in the primary care settings, resulting in excellent patient outcomes without the need for specialist referral. This review should equip primary care physicians with confidence in diagnosing a mallet finger injury, initiating appropriate splinting, providing patient education, and recognizing indications for surgical referral.