Mallet Fracture

What is a mallet fracture?

The phalanx bones (called phalanges in plural) are the long slender bones that form your fingers. There are three phalanges in each of the fingers, and only two phalanges in the thumb. Between each phalanx is a joint or finger “knuckle” that allows the fingers to move.

Fractures are “breaks” or “cracks” in the bone, usually due to trauma. In severe injuries, multiple phalanges can be fractured. Mallet fractures are a common type of phalanx fracture that occurs due to jamming injuries at the end of the finger.

A tendon attaches to the phalanx at the end of each finger, and when this part of the phalanx fractures, then end of the finger droops and won’t extend straight, because the tendon is no longer attached. Sometimes just the tendon ruptures producing the same effect without a fracture (mallet finger).

$A finger broken with a mallet fracture.$

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Overview

Symptoms

Causes

Diagnosis

Why treatment matters

Most mallet fractures can be treated nonoperatively, but occasionally requires surgery. It is important to start treating these as soon as possible, and to stick to the treatment recommendations very carefully as delayed care and noncompliance with splinting often result in poor outcomes, including permanent drooping of the finger, nonunion (nonhealing of the fracture), and sometimes painful arthritis of the finger joint.

Nonoperative treatment:

Splinting is the mainstay of treatment for most mallet fractures. A small splint is applied just to the end joint of the finger, allowing the other two joints to move. The end joint of the finger must be held straight at all times, as allowing it to bend even momentarily can reset the clock for healing or prevent healing altogether. We will show you techniques for cleaning and inspecting the skin of the finger under the splint without allowing the end joint to bend, then replacing the splint. We typically recommend six weeks of full-time splinting (removing only for hand hygiene), followed by 6 weeks of wearing the splint during high-risk manual activities and also at night-time. Occasionally, more than one round of nonoperative treatment is attempted if the deformity recurs.

Finger with a condition called mallet finger in an alumafoam splint. Finger splinted with a stax splint.

Stax Splint and Alumafoam Splint for Mallet Fracture

Operative treatment:

We recommend surgical repair for larger mallet fractures that allow the end joint of the finger to slip out of alignment. X-rays are useful to determine which mallet fractures need surgery. We administer mild sedation, numb the finger, and place two or three small metal wires through the skin and into the bone to hold the fracture pieces and joint in the proper alignment while it heals.

Take the next step

Our board-certified specialists are here to help you heal. They can often diagnose the problem in one visit and get you started with a personalized treatment plan. We offer a wide variety of treatment options.