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(Tuesday, 23rd Dec, 2014)

Mallet finger - not healing?

After an accident while gardening I have what I think is called a mallet finger. It affects the middle finger on my right hand. I am right handed. The section of my finger with the nail on it flops from that end joint and I have no control over its movement. I have been wearing a splint from the beginning. However, I was unaware that I had to immobilise the finger from the centre joint. I have been wearing the splint now for about six weeks, including that first week when the finger was not properly immobilised. I took the splint off last week and there seemed to be no change. I have been given an appointment for next week, which is seven weeks after the accident. I have been unable to get much information, except that it should self heal and if it doesn’t a wire will need to be inserted. Could you please explain the condition to me and what can I expect in relation to recovery?

The first thing I would say to you is to put the splint back on your finger. It takes a minimum of six weeks for a mallet finger to heal with splinting and by your own account the finger has only been properly splinted for five. Mallet finger is due to damage to the tendon that is involved in extending the distal joint of the finger. Very often the tendon is avulsed from the bone and may have a small flake of bone attached from the point of avulsion. When this injury occurs the distal joint remains slightly flexed and the affected person is unable to fully extend the tip of the finger. The purpose of splinting is to keep the joint extended thereby keeping the avulsed tendon in close proximity to the point of separation from the bone. This facilitates a natural process of healing. In many cases simple splinting is sufficient to cure the condition however, in some cases the tendon does not re-unite and the tip of the finger continues to be slightly flexed. In that scenario the tendon needs to be repaired surgically. This usually involves the insertion of a thin surgical wire that reconnects the tendon to the point of bone from which it was originally separated. Given the fact that you took the splint off your finger last week the chances of requiring a surgical repair have probably increased. However, as stated at the outset, you should put the splint back on and leave it on until you see the specialist.


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