Mallet finger surgery is an operation to repair a mallet finger injury — where the extensor tendon at the tip of the finger is torn or avulsed with a bone fragment, causing the fingertip to droop and inability to straighten the distal joint.
For bony mallet (fracture involving more than one-third of the joint surface with subluxation): a small incision is made over the DIP joint. The fracture fragment is reduced and fixed with a small screw or K-wire. For chronic soft tissue mallet or failed splinting: the tendon may be reconstructed or the DIP joint fused in a functional position. The operation takes 30–60 minutes.
Surgery is recommended for bony mallet injuries with joint subluxation, open mallet injuries, failed splint treatment with persistent droop, and chronic mallet deformity causing functional problems.
Most mallet finger injuries (both bony and tendinous) are treated with continuous splinting of the DIP joint in extension for six to eight weeks. This is successful in the majority. Surgery is reserved for specific indications.
X-rays to assess fracture size and joint congruity. Standard pre-assessment.
Restoration of joint congruity and reduction of subluxation for bony mallet. Improvement (though not always complete correction) of the extensor lag for chronic soft tissue mallet.
Some residual droop (5–10 degrees) is common even after successful treatment.
The nail may be affected by surgery near the nail bed.
DIP joint stiffness.
If K-wires are used.
The joint surface may not be perfectly restored.
Wound or joint infection.
Post-traumatic arthritis.
The repair may fail.
Digital nerve block or general anaesthesia.
Splinting of the DIP joint for six to eight weeks after surgery. K-wire removal at six weeks if used. Gentle DIP flexion exercises begin after splint removal. Full recovery three to four months.
X-ray at two weeks. Splint/wire removal at six weeks. Review at three months.
Splinting is successful for most mallet injuries. Surgery is needed when there is a large fracture fragment with joint subluxation (the joint is not congruent), or when splinting has failed to produce an acceptable result.