What is it?
The end joint of your fingertip droops and you cannot straighten it properly. The tendon has pulled off a small fragment of bone. We call this a ‘mallet’ injury. You will be referred to the Hand Fracture Clinic at Arrowe Park Hospital for further management of your mallet finger.
To treat a mallet finger, the joint must be held straight in a splint for 6-8 weeks, as tendons heal only very slowly. If the finger is allowed to bend during this time healing will not occur and the ‘droop’ of the finger will be permanent. The splint should therefore be removed only for cleaning whilst keeping the finger straight.
Most injuries heal without any problems; however, it may take several months to regain full function. There may be redness, swelling or slight pain over the joint for a few months, this will settle. You may be left with a small bump or be unable to straighten the finger fully. If this happens it is unfortunately a permanent feature but will not affect the function of your finger. Often it drops a little after splint removal.
The Mallet Finger Splint
The mallet finger splint is a simple and effective way to treat this injury. The splint is designed to keep the joint straight while the tendons heal.
- The splint will be applied and should be worn continuously, even at night, to keep the finger straight for 8 weeks. Ensure it is always taped securely. There is a risk that removal of the splint will cause the healing process to go back to day 1.
- After 8 weeks wear the splint at night for a minimum of 2 weeks then wean off gradually. Keep checking the joint as you do this. Please avoid forcing the finger into a bent position during this time.
- The splint is not designed to interfere with your daily life. Using your hand normally will prevent stiffness of the uninjured joints. You can return to work unless the splint infringes on hygiene or food safety regulations, or if it would put you at further risk of further injury on machinery.
How do I keep my finger and splint clean?
The splinted finger must be kept clean and dry at all times. If the skin becomes wet inside the splint, it will become very sore. Try to limit washing the finger to reduce the chance of the finger bending. Initially aim to clean your finger twice a week following these instructions:
- You can remove the splint to wash your finger. Gently rest the tip, palm side down, on the edge of a table. Carefully remove the tape and slide the splint off, keeping the finger supported.
- Wash the skin using soap and water and thoroughly dry it before re-applying the splint. Keep the end joint straight at all times by keeping your finger flat on the table. You may find it easier if someone helps you to do this each day, as any movement of the end of the finger will delay healing of the tendon and may even cause permanent damage.
- Slide the splint back over the fingertip, still keeping the finger straight.
- Secure the splint with fresh tape.
You should:
- Keep your hand elevated whilst your finger is swollen.
- Try to exercise all the joints, except the one in the splint.
- Wear the splint all the time.
- Attend your follow up as advised.
- It is important that you regularly exercise the joints that are not included in the splint. With the splint on you should be able to bend the finger so that the end of the splint touches your palm. If the splint is preventing you from doing this please contact the Hand Therapy Team.
- It is important to keep the finger and splint dry to avoid skin irritation.
You should not:
- Attempt to examine the healing by bending the fingertip until advised by the treating
doctor. - Wear any rings on this hand until the injured finger has healed. All rings must be
removed to avoid swelling and circulation problems
Problems you may have:
- The swelling in your finger may go down, which means the splint is now too big. It will need to be changed. If this happens, please contact the Fracture clinic on 0151 604 7069 to arrange for a new splint to be fitted.
- The swelling may increase, making the splint too small. It may have to be changed, please contact the Hand Clinic.
- If your finger drops very badly when you remove it at the end of 8 weeks, please contact the Hand Fracture clinic arrange review on 0151 604 7069.
- You may have problems getting the splint on and off. You will need further advice and might need to be shown again.
- When you take off the splint for washing, check your finger for red areas where the splint may be rubbing. Check also for blisters and sores.
- There is a risk of a pressure-sore forming if your splint is applied too tightly. If you feel your splint is too tight and it is causing discomfort, or you notice any colour changes in the skin when washing, please contact the Hand Clinic.
Ongoing care
Please contact the Hand Fracture clinic on 0151 604 7096 if you have any ongoing concerns regarding your Mallet Finger.
- After the splint has stopped being used it is important to start gently moving the finger and gradually resume daily activities within the limits of discomfort. At first the finger may not bend easily at the end joint. This will ease off after a few days. If you are struggling to get the movement back, please contact the Hand Clinic.
- There may be redness, swelling and slight pain over the joint for a few months afterward. This will settle.
- You may be left with a small bump or be unable to straighten the finger fully. If this happens it is unfortunately a permanent feature but will not affect the function of your finger. If the finger is perfectly straight, you have an excellent result. Often it drops a little, after splint removal.
Exercises 2-3 times per day
- Bend your fingers into a hook position (with the smaller finger joints bent and the larger knuckles straight).
- Bend your fingers into a fist.
- Straighten your fingers. If the joint will not go fully straight you can help it with your other hand.
For the first 2-4 weeks after daytime splint removal DO NOT:
- Bend your affected joint with your other hand.
- Use your hand for any medium or heavy activities.
- Do any repetitive activity with your affected finger.
Occasionally even after 3 months of splint treatment the injury may fail to heal. Most fingers function well despite a droop at the end joint. If you are concerned please contact the Hand fracture Clinic. (0151 604 7096).
Please contact your GP or NHS111 for any queries or concerns.
Reference: Mallet Finger Leaflet, Orthopaedic Department, Wirral University Teaching Hospital NHS Foundation Trust.
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