Mallet thumb injuries are much less common than the mallet finger, but this lesion may also occur as a result of athletic activity. These injuries constitute 2% to 3% of all mallet injuries, and diagnosis is usually apparent by the inability to actively extend the interphalangeal joint of the thumb. Radiographs are usually within normal limits, although occasionally a small avulsion fracture is noted.
Most authors recommend78 conservative treatment of this lesion. Din and Meggitt,79 in 1983, recommended open repair because the extensor pollicis longus is thicker than the digital extensors, and they noted a significant gap between tendon ends at the time of exploration. Miura et al,80 on the other hand, treated 25 of 35 mallet thumb injuries with extension splints and noted that satisfactory extension was present in 84%. These authors also noted that patients who received treatment within 2 weeks following injury obtained more satisfactory results compared to those who were treated at later than 2 weeks.
Athletes can frequently continue to participate in their sport during treatment of mallet thumb. In ball-handling positions in football, the thumb may be taped to prevent full flexion during play and splinted in extension when not participating.
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