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Modified Ultrasonographic Classification of Tendinous Mallet Injuries Based on a Combination with Wang Classification

Jihae Lee¹, Suk Ha Jeon², Sanglim Lee³

¹Department of Radiology, Inje University Sanggye Paik Hospital, Seoul, South Korea.

The Journal of Hand Surgery Asian-Pacific Volume

|May 12, 2026

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A new ultrasonographic classification refines tendinous mallet injury assessment by adding lateral band involvement subtypes. This improved classification aids in better diagnostic accuracy and predicting functional outcomes for mallet finger injuries.

Area of Science:

Orthopedics
Radiology
Sports Medicine

Background:

Ultrasonography is valuable for soft-tissue injury assessment but lacks a defined role in classifying tendinous mallet injuries.
Existing classifications may not fully capture the nuances of these injuries, impacting diagnostic accuracy and prognosis.

Purpose of the Study:

To propose and validate a modified ultrasonographic classification system for tendinous mallet injuries.
The system integrates Wang's classification with new subtypes to emphasize lateral band involvement, aiming for improved diagnostic precision and prognostic assessment.

Main Methods:

A retrospective cross-sectional study involving 36 patients with acute closed tendinous mallet injuries.
Ultrasonographic evaluation was performed, and Wang's Type B was subdivided into B1 (complete terminal tendon rupture) and B2 (lateral band slip rupture).

Keywords:

Classification system Lateral band rupture Mallet finger Tendon injury Ultrasonography

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Clinical outcomes, including pinch strength, pain, extension lag, and functional scores, were assessed at a minimum 4-month follow-up.

Main Results:

Fifteen Type B1, eight Type B2, and 13 Type C injuries were identified.
Increased injured tendon length correlated with weaker relative pinch strength across all types.
Type C injuries had longer tendon lengths than B1 and B2; Types B2 and C showed better functional outcomes (excellent/good) compared to Type B1 (poor/fair).

Conclusions:

The modified ultrasonographic classification offers a more detailed assessment of tendinous mallet injuries.
Distinguishing partial lateral band ruptures enhances diagnostic accuracy.
This refined classification system shows potential for improving functional prognostication in patients with mallet finger injuries.