Mallet finger results from disruption of the terminal extensor tendon at zone 1 — at or just proximal to its insertion on the dorsal base of the distal phalanx. The mechanism is forced DIP flexion against active extension (hitting a ball, opening a drawer, tucking bedsheets). The injury may be a tendon rupture without bone, or a bony mallet with an avulsion fragment from the dorsal distal phalanx.
Mallet finger presents with the DIP joint held in flexion with inability to actively extend it. The Doyle classification distinguishes: Type I (closed tendon rupture, most common), Type II (open laceration), Type III (skin and tendon loss), Type IVA (physeal injury), Type IVB (volar articular surface less than 50%), Type IVC (volar surface over 50% with subluxation). Treatment: splint the DIP in full extension (not hyperextension) for 6-8 weeks for soft tissue mallet; surgical fixation for fracture-dislocation with joint subluxation.
Forced DIP flexion ruptures the terminal extensor tendon producing an extensor lag at the DIP; the joint rests in flexion and cannot be actively extended; treated by continuous DIP extension splinting for 6-8 weeks, with surgical K-wire fixation for large avulsion fragments causing DIP subluxation.
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