Question 1

What is mallet finger?

Accepted Answer

Mallet finger is injury to the extensor tendon that straightens your fingertip. The tendon either tears, stretches, or pulls off a piece of bone (avulsion fracture). This causes the fingertip to droop at the DIP joint (the fingertip joint). You cannot actively straighten the tip yourself, though someone else can passively straighten it for you. The injury most commonly happens when a ball hits an extended fingertip (hence 'baseball finger'), but in older adults it often happens from minor trauma like tucking in sheets. The index and middle fingers are most commonly affected.

Question 2

What is the difference between tendon mallet and bony mallet?

Accepted Answer

Tendon mallet (70% of cases): extensor tendon tears or stretches without bone involvement. X-ray shows no fracture. Treated with splinting. Bony mallet (30%): tendon pulls off a piece of bone (avulsion fracture) from back of fingertip. X-ray shows bone fragment. Treatment depends on fragment size: small fragment (under 30% of joint) treated like tendon mallet with splinting; large fragment (over 30-40%) or joint subluxation may need surgery (pinning or open repair). Outcomes are similar for both types if treated appropriately.

Question 3

Do I really have to wear the splint for 6-8 weeks continuously?

Accepted Answer

YES - absolutely critical. If the fingertip droops even once during the healing period, the healing tendon pulls apart and you start over from day zero. This is the most common reason for treatment failure - patients cheat by removing splint. The tendon needs 6-8 weeks of continuous protection in extension to heal. To wash your finger, support it on a flat surface to keep it straight while carefully cleaning around the splint with your other hand. Never remove the splint. Studies show strict compliance has 75-80% success; poor compliance has 40-50% success.

Question 4

Will my fingertip be completely straight after treatment?

Accepted Answer

Usually no - most people have 5-15 degree permanent extension lag (residual droop) even after successful treatment. This is normal and acceptable. It rarely affects function or grip strength. Only 20-30% achieve perfect alignment. The goal is functional improvement, not cosmetic perfection. If droop is 15 degrees or less, you'll barely notice it and it won't affect daily activities. Droop over 30 degrees suggests treatment failure and may need reassessment. Most people are happy with 10-15 degree residual droop after avoiding surgery.

Question 5

When do I need surgery?

Accepted Answer

Surgery needed in specific situations: 1) Large bony fragment (over 30-40% of joint surface), 2) Joint subluxation (volar) - fingertip dislocated forward, 3) Open injury with tendon laceration, 4) Failed splinting after 8-10 weeks (persistent large droop), or 5) Chronic neglected mallet (over 6 months old) causing functional problems. However, 70-80% heal with splinting alone and never need surgery. Your X-ray determines if you have a large bone fragment. If you have tendon-only mallet or small bone fragment, try splinting first before considering surgery.

Medical Disclaimer

Mallet Finger (Dropped Fingertip)

📖What is Mallet Finger (Dropped Fingertip)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention