The affected digit should be splinted in extension at the DIP joint, ideally with a stack splint or figure of 8 splint, for 6-8 weeks . Orthopedics does not need to be consulted in the ED but urgent follow-up should be arranged, especially if there are bony avulsions, to evaluate the need for surgical repair.
- Pearl: Management is typically non-operative with the DIP joint splinted in extension AT ALL TIMES FOR 6-8 WEEKS. If the finger is allowed to flex at the DIP joint even briefly, the clock is reset and an additional 6-8 weeks of extension will be required .
- Pearl: Relative indications for surgical repair include an avulsion fracture involving >30% articular surface or volar subluxation of the distal phalanx .
- Pearl: If a mallet finger isn’t treated appropriately, it is likely to develop into a swan-neck deformity. Due to progressively increased extension tone across the PIP joint and migration of the extensor complex proximally, extension develops at the PIP and the DIP remains flexed (Figure 4) .