title: Review of Acute Traumatic Closed Mallet Finger Injuries in Adults.
abstract: In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.
authors.affiliation: Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France.
authors.forename: Santiago
authors.initials: S
authors.lastname: Salazar Botero
authors.affiliation: Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France.
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Hidalgo Diaz
authors.affiliation: Department of Orthopaedics, CHU Blida, Saad Dahleb University, Blida, Algeria.
authors.forename: Anissa
authors.initials: A
authors.lastname: Benaïda
authors.affiliation: Department of Orthopaedic Surgery, Caen University Hospital, Caen, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Collon
authors.affiliation: Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France.
authors.forename: Sybille
authors.initials: S
authors.lastname: Facca
authors.affiliation: Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France.
authors.forename: Philippe André
authors.initials: PA
authors.lastname: Liverneaux
keywords: Bony mallet; Mallet finger; Mallet fracture