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.
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.