Zone 1 extensor tendon lesions: current treatment methods and a review of literature

The treatment options for the soft-tissue mallet finger, both acute and chronic, continue to generate a certain degree of controversy. Priority should always be given to conservative management of these injuries. This translates into a 6-to-8-week period of uninterrupted immobilization of the DIP joint with an external splint. Splinting has been shown to be highly effective and safe for both acute and chronic lesions. Even in the presence of an open injury, the value of splinting should be appreciated by the practitioner. The conversion of an acute closed, soft-tissue injury to an open one is to be discouraged,due to unacceptable complication rates. When surgery is contemplated, in a selected group of patients, the first option advocated by most authors is the placement of a trans-articular Kirschner wire at the DIP joint and/or conjoint tendon advancement. If external splinting fails in an acute injury, an argument can certainly be made for a second trial of conservative management. It has been found that some patients will not tolerate a second period of immobilization, and in most such cases surgery is offered. In summary, mallet injuries are best treated using closed, nonoperative techniques. The period of time after injury for which this conservative treatment can be prolonged and still be effective is being extended, and the absolute outside time limit remains unknown. Surgical treatment should be reserved for mallet fractures, and in such cases Bunnel's pull-out suture is recommended. Finger rehabilitation is an indispensable part of any method of treatment.