Conservative management of an open lacerated mallet finger injury in an infant: A case report

Abstract

Aim Operative management is suggested for all open mallet injuries using a Kirschner-wire for distal interphalangeal joint immobilisation and direct extensor tendon repair(1), although few published reports exist(2,3). Alternatively, lacerated tendon edges can be approximated with a continuous running suture, and an extension orthosis applied for 6 weeks.4 Conservative management outcomes has not been reported in adult/paediatric populations. Problem A 12-month-old infant sustained an open mallet finger injury (100% terminal tendon laceration) with a kitchen knife. Surgery with Kirschner-wire fixation was recommended by Plastic surgeons on the day of injury, and again in a private clinic when a second opinion was sought two weeks later. Despite recommendations, the parents opted for conservative management, acknowledging success was unknown. Methods Mallet orthoses usually immobilise the distal interphalangeal joint in extension; a larger orthosis immobilising both proximal and distal interphalangeal joints was clinically reasoned due to a smaller orthosis posing a choking hazard; and to prevent swan neck deformity. The finger-based orthosis was taped on full-time for 8 weeks. Results At 8, 10, and 14-weeks and at 2-year follow-up, both the proximal and distal interphalangeal joints measured 0 degrees extension (same as contralateral), and full flexion. No functional limitations were observed or identified by the parents at the 14 week or 2-year assessment time-points. Conclusion Conservative management of an open lacerated terminal extensor tendon resulted in an excellent outcome in this case study. Future research to explore the necessity of surgery in open mallet injuries, may provide us with new alternate management pathways. Impact Conservative management of terminal tendon lacerations that traditionally undergo surgery may lessen the emotional burden on the patient/family and lessen the financial burden on health care systems. References 1 Lamaris GA and Matthew MK. The diagnosis and management of mallet finger injuries. Hand. 2017;12(3): 223-228. 2 Bendre AA, Hartigan BJ, Kalainov DM. Mallet fingers. J Am Acad Orthop Surg. 2005;13(5):336-344. 3 Nakamura K, Nanjyo B. Reassessment of surgery for mallet finger. Plast Reconstr Surg. 1994;93:141-149. 4 Doyle JR. Extensor tendons: acute injuries. In: Green DP, Pederson CW, Hotchkiss RN, eds. Green’s Operative Hand Surgery. 4th ed. New York, NY: Churchill Livingstone;1999:195-198