Mallet Finger or Fracture

Symptoms usually appear right after injury and may include:

• Drooping fingertip or inability to straighten the tip while other joints move normally
• Pain, tenderness, swelling, or bruising at the fingertip (soft tissue)
• Mild pain with attempted extension or a feeling that the finger “catches"
• In some cases, little initial pain occurs, but the droop persists without treatment

In mallet fractures, there may also be tenderness, swelling or bruising specifically over the distal phalanx (the tip bone).

Mallet finger — with or without a fracture — often results from: 

• Sudden "jamming injuries" to the fingers
• Blunt force trauma (work injuries, sports, vehicle accidents)
• Forceful bending of the fingertip during daily activities, like tucking in bed sheets
• Less commonly, sudden tendon rupture due to chronic conditions or disease

In some injuries, the force is strong enough to crack or break the distal phalanx at the tendon attachment (a mallet fracture), rather than injuring only the tendon.

Your hand and wrist surgeon will examine your finger for the characteristic droop and test your ability to actively straighten it. Fractures may be obvious on physical examination, but severe sprains or contusions can appear similar. X-rays are usually needed to confirm whether a fracture of the distal phalanx is present and to guide treatment planning. Early evaluation helps prevent poor healing, such as permanent deformity or nonunion.

Without proper treatment, the fingertip may remain permanently drooped and lead to stiffness or arthritis. Early evaluation and prompt splinting help most people regain normal finger function.

Treatment depends on the severity of the injury, how soon care is started and whether a fracture is involved. Most mallet fingers respond well to nonoperative care when treatment begins early.

Nonoperative care 

Nonoperative treatment focuses on splinting: 

• A small splint holds the end joint straight continuously, removing it only for hygiene
• Full-time splinting is usually recommended for six weeks, followed by nighttime or high-risk activity use for another six weeks
• Your hand and wrist specialist will teach skin care and techniques to avoid bending the joint, even briefly, since this can disrupt healing
• Pain relief, ice and elevation may be used as needed; some cases require repeat splinting if the deformity recurs
• Splints commonly used for mallet fractures include Stax or Alumafoam splints — occasionally, more than one round of nonoperative treatment may be attempted if the droop returns

Operative care

Surgery may be recommended when a mallet fracture is large enough to shift the joint out of alignment. 

• The procedure is typically done under local anesthesia with sedation
• Small pins (K-wires) are inserted through the skin into the distal phalanx to hold the bone and joint in proper alignment while they heal
• X-rays are used to determine which mallet fractures require surgery