The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Hand & Wrist

Mallet Finger

Mallet finger is one of the most common tendon injuries in sports and everyday life. It occurs when the tip of the finger is forcibly bent while the fingertip is held extended — as when a ball strikes the end of an outstretched finger — disrupting the extensor mechanism at the DIP joint and causing the fingertip to droop. With the right treatment started promptly, most mallet fingers heal fully without surgery. Maryland Orthopedic Specialists' hand surgeons diagnose and manage mallet finger injuries at both our Bethesda and Germantown offices.

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What is mallet finger?

The DIP (distal interphalangeal) joint — the last joint at the fingertip — is held in extension by the terminal extensor tendon. When this extensor mechanism is disrupted, the fingertip droops into flexion and cannot be actively extended, producing the classic mallet posture.

The DIP (distal interphalangeal) joint — the last joint at the fingertip — is held in extension by the terminal extensor tendon. When this extensor mechanism is disrupted, the fingertip droops into flexion and cannot be actively extended, producing the classic mallet posture.

Two Types of Mallet Finger

Tendinous Mallet (soft tissue / "pure" mallet): The terminal extensor tendon ruptures from its insertion on the base of the distal phalanx, usually without a bony fragment. Caused by a sudden forced-flexion injury to the extended fingertip. Tendons cannot be directly sutured in this location due to the anatomy; treatment relies on continuous uninterrupted extension splinting.

Bony Mallet (mallet fracture): The extensor tendon avulses a bony fragment from the dorsal base of the distal phalanx rather than tearing through tendon substance. The size of the fragment and whether volar subluxation of the distal phalanx is present are the critical surgical decision points:

  • Small fragment (< 30% of articular surface), no subluxation: Treat as a soft-tissue mallet — continuous extension splinting
  • Large fragment (> 30–50% of articular surface) or volar subluxation of distal phalanx: Surgery is indicated

The distinction between tendinous and bony mallet is made on X-ray.

Treatment options

Non-Operative

Continuous extension splinting of the fingertip for 6 to 8 weeks is the cornerstone of treatment and produces excellent results in most patients. The splint must not come off even once during the healing period, as any bending of the fingertip restarts the clock. Starting treatment promptly gives the best chance of full recovery.

Surgical Procedure

Wrist Arthroscopy

Diagnostic and operative arthroscopic evaluation of the wrist joint to assess and treat TFCC tears, scapholunate ligament injuries, synovitis, and loose bodies with minimal disruption to surrounding structures.

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Frequently Asked Questions

What happens if I don't treat a mallet finger?
Without treatment, the extensor tendon heals with elongation, leaving a persistent DIP extension lag. Over time, a swan-neck deformity can develop. Chronic bony mallets with volar subluxation can lead to DIP joint arthritis.
Can mallet finger heal on its own without a splint?
Spontaneous healing sufficient for functional use can occur, but an extension lag typically remains. Splinting optimizes the likelihood of full recovery and should always be attempted.
Is the splint waterproof?
Standard Stack splints tolerate brief water exposure but should be dried promptly. We can provide waterproof options and demonstrate how to safely replace the splint during bathing.
How long do I have to wear the splint for mallet finger?
The standard treatment for a tendinous mallet finger is continuous splinting of the fingertip in full extension for 6–8 weeks, with the key rule being that the tip must never be allowed to bend during this period — even briefly. After the initial phase, your MOS surgeon may recommend a gradual weaning protocol over an additional 4–6 weeks, often starting with nighttime splinting. If the splint comes off and the finger droops, the 6–8 week clock typically restarts. Compliance with continuous splinting is the single most important factor in achieving a good outcome without surgery.
Will I need surgery for a mallet finger, and what does it involve?
The majority of mallet fingers — including tendon injuries and small avulsion fractures — heal successfully with splinting alone and do not require surgery. Surgery is considered when a large bone fragment (involving more than one-third of the joint surface) has displaced and shifted the fingertip joint out of alignment (subluxation), or when splinting has failed after an adequate trial. Surgical options include pinning the joint in extension or fixing the bony fragment back in place. Your MOS hand surgeon will review your X-rays and clinical picture to determine whether operative or non-operative treatment gives you the best long-term result.

Meet the specialists

Peter G. Fitzgibbons, MD

Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Related conditions

Extensor Tendon RuptureTendon LacerationJoint Dislocations in the Hand
Medically reviewed by Peter G. Fitzgibbons, MD, MD
Last reviewed May 1, 2026

References

  1. Alla SR, Deal ND, Dempsey IJ. Current concepts: mallet finger. Hand (New York). 2014;9(2):138–144. doi:10.1007/s11552-014-9609-y
  2. Handoll HH, Vaghela MV. Interventions for treating mallet finger injuries. Cochrane Database of Systematic Reviews. 2004;(3):CD004574. doi:10.1002/14651858.CD004574.pub2
  3. Bendre AA, Hartigan BJ, Kalainov DM. Mallet finger. Journal of the American Academy of Orthopaedic Surgeons. 2005;13(5):336–344. doi:10.5435/00124635-200509000-00006
  4. Tocco S, Navarro R, Branas G, Mansat P. Treatment of mallet fractures: comparison of closed and open methods. Journal of Hand Surgery (European Volume). 2021;46(2):131–136. doi:10.1177/1753193420944975