Operative and nonoperative treatment of mallet finger

Forty-four patients with 47 mallet fingers were reviewed to compare the results of operative (24 fingers) and nonoperative (23 fingers) treatment. Distal interphalangeal (DIP) joint extension, DIP flexion, total active motion of the DIP joint, proximal interphalangeal (PIP) extension, PIP flexion, total active motion of the PIP joint, cold intolerance, and persistent pain after treatment were not significantly different in patients treated by surgery or splinting. Secondarily, we compared fingers with and without a fracture of the distal phalanx, and the variables mentioned above were also unaffected by the presence or absence of fractures of the distal phalanx. About one-third of all patients had decreased PIP joint motion following treatment. In about 16% of all patients this loss of PIP motion was more important in determining finger function than DIP motion or symptoms related to the DIP joint. We recommend careful examination of the PIP joint and repeated monitoring of the joint motion. If the PIP joint becomes stiff, therapy and splinting should be used to minimize permanent stiffness. We believe a prospective randomized comparison of operative and nonoperative treatment of mallet finger should be conducted. Such a study would help determine the ideal treatment for mallet finger.