What is Mallet Finger and what causes it?

Mallet finger is a condition that prevents the end joint of your finger from fully straightening. It occurs when the extensor tendon, responsible for straightening your finger, is damaged. This damage is often a result of a sports injury, accident, or even a minor mishap. The inability to straighten the fingertip is the hallmark sign of this condition.

What are the primary treatment options for Mallet Finger?

The primary treatment option for Mallet Finger is typically splinting, which is often the initial approach. However, when Mallet Finger becomes chronic, meaning it has persisted for weeks or months, surgical reconstruction of the oblique retinacular ligament (ORL) may be necessary. The ORL reconstruction aims to restore the natural mechanics of the finger, allowing automatic straightening of the fingertip. The study discussed focused on ORL reconstruction comparing the lateral band technique and the free tendon graft technique.

What are the differences between the Lateral Band Technique and the Free Tendon Graft Technique for ORL reconstruction?

In the Lateral Band Technique (Group A), a portion of the patient's own lateral band is used to reconstruct the ORL. This involves releasing and rerouting the lateral band. In contrast, the Free Tendon Graft Technique (Group B) employs a tendon graft, often sourced from the palmaris longus, to reconstruct the ligament. The Free Tendon Graft Technique further divides into two methods for tendon fixation: the pull-in suture technique (B-I) and the Mitek bone anchor method (B-II). The choice between these methods, or the choice of the reconstructive technique itself, didn't show a statistically significant difference in functional outcomes.

How do the pull-in suture technique and the Mitek bone anchor method differ in ORL reconstruction?

Both the pull-in suture technique and the Mitek bone anchor method are methods used to secure the tendon during the Free Tendon Graft Technique (Group B) for ORL reconstruction. The pull-in suture technique (B-I) uses sutures that are pulled into the bone to secure the tendon. The Mitek bone anchor method (B-II) utilizes a Mitek anchor to attach the tendon to the bone. Neither technique demonstrated a significant advantage in the study regarding functional outcomes.

What factors should be considered when choosing a surgical technique for Mallet Finger?

The choice of surgical technique for correcting Mallet Finger should be made in consultation with a qualified hand surgeon. The severity and duration of your condition, the integrity of your existing tissues, and your surgeon's experience will all play a crucial role in determining the best course of action. The study indicates that both the lateral band and free tendon graft ORL reconstructions are valid treatment methods, suggesting that the surgeon's expertise and the specific characteristics of your injury will be key factors in the decision-making process.

Surgical illustration of mallet finger repair highlighting tendon reconstruction.

Mallet Finger: Is Surgery Your Best Bet for a Straight Finger?

Nico Varela in Health & Wellness December 2025 • 5 min read.

"Explore the latest on mallet finger surgery, comparing techniques to help you decide if it's the right path for restoring your finger's function and appearance."

Mallet finger, characterized by the inability to fully straighten the end joint of your finger, can significantly impact hand function. This common condition arises when the tendon that straightens your finger (the extensor tendon) is damaged, often due to a sports injury, accident, or even a seemingly minor mishap. Understanding the treatment options available is crucial in regaining full use of your hand.

While splinting is often the first line of defense, chronic mallet finger, where the condition has persisted for weeks or months, may require more intervention. In these cases, surgical reconstruction of the oblique retinacular ligament (ORL) becomes a viable option. This procedure aims to restore the natural mechanics of your finger, allowing for automatic straightening of the fingertip as you bend the middle joint.

Two primary surgical techniques exist for ORL reconstruction: one using a strip of tissue from your own hand (lateral band), and another employing a free tendon graft from another part of your body. This article delves into a comparative study of these methods, weighing their pros and cons to help you understand which approach might be best suited for your specific needs. We'll also explore different methods of securing the tendon during surgery and their impact on recovery.

Lateral Band vs. Tendon Graft: Which Mallet Finger Surgery is Right for You?

Surgical illustration of mallet finger repair highlighting tendon reconstruction.

When it comes to surgically correcting mallet finger, the choice between using a lateral band from your own finger versus a free tendon graft is a significant one. A study published in the Archives of Plastic Surgery compared the outcomes of these two techniques, offering valuable insights for both patients and surgeons. The study retrospectively reviewed 27 cases of ORL reconstruction, categorizing them into lateral band (Group A) and free tendon graft (Group B) procedures.

Researchers meticulously collected data on patient demographics, injury mechanisms, surgical techniques, and pre- and post-operative extension lag (the degree to which the finger couldn't straighten). Group B was further divided based on the method of tendon fixation: pull-in suture technique (B-I) and Mitek bone anchor method (B-II). This detailed approach allowed for a comprehensive comparison of the effectiveness of each surgical strategy.

Lateral Band Technique (Group A): Uses a portion of the patient's own lateral band, releasing and rerouting it to restore the ORL.
Free Tendon Graft Technique (Group B): Employs a tendon graft (often from the palmaris longus) to reconstruct the ligament.
Pull-in Suture Technique (B-I): Secures the tendon using sutures that are pulled into the bone.
Mitek Bone Anchor Method (B-II): Utilizes a Mitek anchor to attach the tendon to the bone.

The study revealed that both ORL reconstruction techniques led to an improvement in the mean DIP extension lag, with an average improvement of 10 degrees. However, neither the choice of reconstructive technique (lateral band vs. tendon graft) nor the bone fixation method (pull-in suture vs. Mitek anchor) showed any statistically significant difference in functional outcome. This suggests that both approaches are viable options for correcting mallet finger.

Making the Right Choice for Your Finger

Ultimately, the decision of which surgical technique to pursue for mallet finger correction should be made in consultation with a qualified hand surgeon. Factors such as the severity and duration of your condition, the integrity of your existing tissues, and your surgeon's experience will all play a role in determining the best course of action. While this study suggests that both lateral band and free tendon graft ORL reconstructions are valid treatment methods, understanding the nuances of each approach will empower you to make an informed decision and embark on the path to restoring full function to your finger.