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Mallet finger fracture repair
Mallet finger fracture repair treats a fracture at the base of the fingertip bone where the extensor tendon attaches, which occurs alongside a mallet finger injury and prevents the fingertip from straightening. Surgery realigns and stabilises the fractured fragment, often with a pin or screw, to restore joint alignment and function.
At a glance
Anaesthetic
Commonly general anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately one week after surgery
Driving
Restricted until the wire is removed and you can grip the steering wheel strongly with both hands
Post Operative Hand Therapy
Required for splinting and subsequent rehabilitation
Splinting
Yes - a mallet splint is worn continuously for approximately 6-8 weeks, even after wire fixation
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Usually 8 weeks before resuming full unrestricted use of the fingertip
Surgical fixation of a mallet fracture (extensor tendon bony avulsion at the fingertip)
A mallet fracture is a break at the base of the distal phalanx where the extensor tendon attaches, causing the fingertip to droop and lack active straightening. Surgery restores the position of the bony fragment, most commonly with two fine, straight wires, to place the bone fragments close to each other, and restore the joint surface and tendon attachment.
Who is this procedure for?
- People with a large bony fragment (typically involving more than around a third of the joint surface) at risk of the joint subluxing (partially dislocating) if left untreated
- People whose fingertip joint is subluxed or unstable on x-ray (see image, right)
- People who have failed a trial of splinting, with the fragment displaced or the joint remaining unstable
- Not usually needed for a small bony fragment with a well-aligned, stable joint, which is typically treated with splinting alone
What does the surgery involve?
Surgery is most commonly performed by passing a fine wire across the distal interphalangeal (fingertip) joint to hold the joint in extension while the bony fragment heals, usually combined with a second (‘dorsal blocking’) wire to capture and hold the fragment itself. In some cases, an extension block pinning technique is used to reduce and hold the fragment without opening the joint. Open reduction with a small screw is occasionally used for larger or more complex fragments.
Alternatives to surgery
Surgery is one option for a mallet fracture. Depending on your situation, the alternatives may include:
- Splinting alone: the standard treatment for most mallet fractures without joint subluxation, using a mallet splint worn continuously for 6-8 weeks
- Extension block pinning versus open fixation: the choice depends on fragment size, displacement, and whether the joint is subluxed
What happens if left untreated: an untreated unstable mallet fracture can lead to a persistent droop of the fingertip, joint subluxation, and early arthritis of the distal interphalangeal joint.
Dr Tomlinson will discuss which options suit your specific injury at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. Most desk-based work can continue with the finger splinted or wired. Manual work involving the affected finger will need modification until the wire is removed. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a plaster cast or splint, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for at least two weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 1 week after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication – your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A mallet splint is worn continuously, day and night, for approximately 6-8 weeks, even when a wire has been used, since the wire alone does not fully protect the joint from accidental bending.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Yes, you will need to see a hand therapist soon after surgery for splinting, and later for recovery of movement after the wires are removed.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- A residual extensor lag (inability to fully straighten the fingertip), which can occur even with successful surgery
- Nail ridging or deformity, particularly with fixation techniques that pass close to the nail bed
- Pin site infection or bone infection (osteomyelitis)
- Joint stiffness or, less commonly, joint surface irregularity
- Nonunion or displacement of the bone fragment
- ‘Swan neck deformity’
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review. Your initial dressing is a half plaster that prevents use of all your fingers. Once you are changed over to the individual finger splint that is made by your hand therapist you may use your hand for light activities, but must not lift objects greater than 300 grams.
Second week
The wire and splint remain in place, holding the fingertip joint straight. The fragment and tendon attachment are healing during this period and the joint must not be allowed to bend. Rest is important to facilitate healing of the broken bone.
6 weeks
The wires will be removed in hospital at this time, but you will need to wear your plastic splint for a further two weeks, or as directed by your surgeon on the basis of your x-ray and hand progress at this time.
3 months
Your range of flexion is gradually increasing as you work on the range of movement using exercises recommended by your hand therapist. Joint stiffness may take up to 12 months to settle.
Long term
Bone strength should return to normal. A degree of extensor lag persists in at least 5% of individuals even with successful treatment.
Want to know more about Mallet Fracture Repair?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.