The term mallet finger fracture describes an avulsion fracture of the top of the finger, just behind the fingernail. Mallet finger fractures are the result of forced flexion of the finger while the long extensor tendon resists the flexion. If the force of flexion is great enough, the long extensor tendon will avulse (pull) a small fragment of bone from the most distal bone in the finger resulting in a mallet finger fracture. Mallet finger fractures are common in the ER and are treated conservatively by splinting the finger in an extended position while the fracture heals.
Mallet fractures of the toes are a very uncommon injury. In this case presentation, our patient is a 30 y/o male with a BMI of 36. He was horsing around with his buddies when he sustained a mallet toe fracture of the right great toe. He states that he stumbled while one of his friends was standing on his foot.
X-rays of the foot proved difficult to define this unique fracture due to the degree of displacement of the mallet toe fracture. Three dimensional CT images were helpful in reconstructing the injury which clearly defines an avulsion fracture of the distal phalanx of the great toe.
Treatment of this injury was conservative using a glass fiber turf toe plate to splint the toe. Surgical correction would have been entertained if the avulsed fragment was larger and comprised more of the interphalangeal joint.
Mallet toe fractures are a rare injury that can often be difficult to diagnose without 3D tomography. Treatment, whether surgical or conservative is always supplemented with a turf toe plate or carbon fiber plate.
Jeffrey A. Oster, DPM