The Journal of Bone and Joint Surgery, Vol 66, Issue 5 658-669, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Mallet fractures
MA Wehbe and LH Schneider
In a review of 160 mallet fingers, forty-four were found to have a fracture
of the distal phalanx. Of these mallet fractures, twenty-one could be
followed for a mean of 3.25 years (range, six months to eight years). Six
had been treated surgically and fifteen had simply been splinted. Of these
twenty-one mallet fractures, all but one had a good result irrespective of
the form of treatment. Bone-remodeling occurred in all digits (including
two with fibrous union), with reconstitution of the articular surface and
preservation of the joint space as seen on radiographs. There was also a
near-normal range of painless motion in all but one finger. Poor patient
compliance was an occasional difficulty when conservative treatment was
used. Surgical treatment was difficult and unreliable; it offered no
advantage over conservative treatment and had a greater rate of morbidity.
The major "complication" of both forms of treatment was a bone prominence
on the dorsum of the distal interphalangeal joint. These findings suggest
that most mallet fractures can be treated conservatively, ignoring joint
subluxation and the size and amount of displacement of the bone fragment.
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