Traumatic Mallet Hallux: Two Case Reports With Distinct Treatment Approaches

Traumatic mallet hallux, an avulsion injury of the extensor hallucis longus tendon or its bony insertion, is rare and often underdiagnosed, with no established treatment guidelines. We report two cases illustrating distinct management approaches based on fragment size and interphalangeal (IP) joint congruency. The first case - a nondisplaced avulsion fracture involving 30% of the articular surface - was successfully treated conservatively with extension splinting, achieving full recovery at three months. The second case - a 50% articular fracture with volar subluxation - required open reduction and internal fixation with a single screw, allowing early mobilization and complete functional restoration by three months. These cases highlight the importance of individualized treatment, where conservative management is suitable for stable injuries while surgery is indicated for displacement or joint incongruence.