Mallet fractures.

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.