Mallet (Baseball) and Jersey Fingers Reviewed

In this review article doctors from the University of Cincinnati College of Medicine discuss two kinds of common finger injuries. The first type is a Mallet (or baseball) finger, which refers to the shape of the fingertip after the extensor tendon is ruptured.

Jersey finger is the opposite injury with rupture or avulsion of the flexor tendon. This type of injury occurs most often when a football player grabs another player's jersey with the tip of his finger while the other team member pulls away. The force of the action hyperextends the tip of the finger while the rest of the finger is bent. Both injuries affect the tip or distal phalanx of the finger.

Anatomy, type of injury, diagnosis, and treatment are the main review points for each injury. Different ways to divide the finger deformities into groups are also presented. These are called classification schemes.

Treatment is based on the classification. For example, most Type I injuries (partial rupture of the tendon) can be treated without surgery. A finger splint is used to hold the digit in place until healing occurs. Type II (full tendon rupture) and III (rupture with bone chip attached) require surgery to repair the soft tissue damage.

Specific surgical techniques with and without pins are discussed. The placement of pins depends on the type of injury. The use of internal sutures, tension banding, screws, and wires is also reviewed. Sometimes fusion or a tendon transfer is needed.

Complications after surgery are common, often resulting in long-term disability. Infection, pin failure, and nail and joint deformity are reported in up to half of all cases.

The authors point out the best treatment is nonoperative to avoid the many complications and problems after surgery. They suggest that only patients with fractures or joint dislocations that can't be repaired with splinting should be treated surgically.