Baseball Finger or Mallet Finger Injuries
Mallet finger is a deformity of a finger caused when the extensor tendon at the joint closest to the fingertip is damaged. When a ball or other object strikes the tip of the finger or thumb, the force damages the thin tendon that straightens the finger. The force of the blow may tear the tendon or even pull away a piece of bone along with the tendon. The finger or thumb cannot be actively straightened. This condition is also known as "Baseball Finger." The source of the trauma is not always violent; it is common for seemingly mundane events such as tucking in a bedspread or pulling down socks or stockings while holding the finger straight to provoke these injuries.
The finger may be painful, swollen, and bruised at the joint nearest the fingertip after a jamming type injury. Most importantly, the fingertip may droop noticeably, and can only be straightened with assistance.
In most cases, the doctor will order X-rays in order to look for an associated fracture or malalignment of the joint contributing to the loss of active extension
The majority of mallet finger injuries can be treated without surgery. Ice can be applied immediately and the hand should be elevated if there is swelling. Medical attention should be sought within a week after injury. It is very important to seek immediate attention if there is blood beneath the nail or if the nail is detached. This may be a sign of nail bed laceration or open (compound) fracture.
The doctor may apply a splint to hold the fingertip straight (in extension) until it heals. Alumafoam splints can be applied to the top or palmar side of the fingertip, or there are formed plastic splints as well. In any case, the role of the splint is to maintain the finger in a straight or extended position which allows healing of the injured tendon in the appropriate position. Most of the time, a splint will need to be worn full time for six to eight weeks. During this phase, it is critically important that the finger is supported at all times as even short periods unsupported can stretch the early healing scar tissue repairing the tendon. Over the next three to four weeks, most patients are advised gradually begin to wean from the splint. Although the finger usually regains an acceptable function and appearance with this treatment plan, many patients may not regain full fingertip extension.
In children, mallet finger injuries may involve the cartilage that controls bone growth. The doctor must carefully evaluate and treat this injury in children, so that the finger does not become stunted or deformed.
Surgical repair may be considered when mallet finger injuries are associated with lacerations or where there are large fracture fragments or joint malalignment is present or can be anticipated. In these cases, surgery is done to repair the fracture and stabilize the joint using pins, pins and wire, or even small screws. Surgery may also be considered if nonsurgical treatment fails (this is only rarely necessary).
An orthopedic or hand surgeon should be consulted in making the decision to treat this condition either conservatively or surgically. Typically, very satisfactory results can be expected after these injuries. It is very important, however, that careful attention is applied to the details of treatment, for example absolutely full time use of splints during the immediate post injury treatment phase, if this favorable outcome is to be enjoyed.
Lawrence Lee, MD