Open Mallet and Skin Graft 2013-04-29T15:01:11+00:00

Open Mallet and Skin Graft 

A mallet finger or sometimes called a baseball finger, dropped finger or dolphin finger is the result of an extensor tendon injury. The extensor digitorum tendon of the finger at the distal inter-phalangeal joint is either transected as in an open injury or avulsed with or without a piece of bone from the distal phalanx as in a closed injury. Closed injury results from hyper-flexion of an extended digit like when an object such as a ball (softball, basketball, baseball or volleyball) strikes the end of the out-streched finger creating a ruptured or stretched extensor digitorum tendon.

Open injuries and closed boney mallet injuries involving more than 30% or the articular surface or associated with volar dislocation of the distal phalanx are generally treated surgically and the tendon and/or bone is repaired.

Closed mallet injury treatment options include putting the finger in a Mallet splint for 6 to 8 weeks or possibly longer or surgically inserting an extension block k-wire in non-compliant patients.  The splint allows the tendon to return to normal length or re-attach to the bone, if the finger is bent during these weeks the healing process must start all over again.

 

This gentleman put his hand through a plat glass window sustaining several injuries. skin loss over the dorsal aspect of the little finger metacarpi-phalangeal joint and laceration distal to the proximal inter-phalangeal joint with the classic mallet deformity of flexed posture of the distal inter-phalangeal joint and inability to actively extend this joint. Indicating transection of the terminal extensor digitorum tendon.

 

 

 

Dorsal view of soft tissue deficit and lacerations. All lacerations were explored only the little finger involved tendon.

 

 

 

 

 

 

Fulll thickness skin graft is sutured into place after exploration of all wounds and repair of the extensor tendon to the little finger distal phalanx.

 

 

 

 

 

Wrist placed in extension checking the normal tenodesis effect of the digits.  With wrist flexion the digits all extended fully.

 

 

 

 

 

 

This patient was lost to follow up and represented about a year after his initial repair with injury to the index finger and evidence of some additional superficial trauma to the metacarpi-phalangeal joints. of note he demonstrated a completely healed skin graft and full extension of the inter-phalangeal joints indicating complete extensor tendon healing and function.

 

 

 

Full flexion of metacarpo-phalangeal joint and inter-phalangeal joints is evidence of an excellent result and full correction of the open mallet injury.