I am a piano teacher but also a softball coach for a neighborhood girls' team. At practice last night, I got hit by a ball and broke my finger. They called it a mallet fracture and I can see why -- the tip of my finger was bent making the finger look like a tiny gavel or mallet. The emergency room at our local hospital put a splint on it and told me to wear it for six weeks. But I can't play the piano and that's a major problem when giving lessons. Is there anything else they can do to treat this without limiting my motion?
At first glance, mallet finger fractures can seem like a no big deal kind of problem. Put a splint on it and you're better in six weeks. But as you just discovered, when you need every finger and every joint of every finger to do your job, the injury just got very complicated.
Occasionally surgeons face this same problem. Without the full use of their hands, they can't operate. So we turned to a recently published article by a hand surgeon who also suffered a mallet finger fracture from a skiing injury. He reviewed all of the literature on these kinds of finger fractures to find out what's the best way to treat it.
Mallet injuries can be fairly complex. The surface of the finger joint can be involved. There is avulsion (rupture) of the tendon. The joint may become subluxed (partially dislocated) or fully dislocated. Depending on the location and severity of the injuries, treatment may be accomplished either with a splint to immobilize the joint or surgery to repair the damage.
Surgery involves using a pin to hold the bone fragments together. The pin functions like an internal splint to allow the patient to keep using the hand (such as in the case of a surgeon or piano teacher).
But there can be problems associated with the pin such as infection, failure to hold the fractured bone together while it heals, and loss of skin as a result of the infection. So that's why splinting is tried first. Surgery is usually saved for complex injuries or splinted injuries that just don't heal. Given your situation, you may want to see an orthopedic surgeon to see if you could be a candidate for a pin that would allow you to continue moving and using your finger while tickling the ivories!
Charles Leinberry, MD. Mallet Finger Injuries. In The Journal of Hand Surgery. November 2009. Vol. 34A. No. 9. Pp. 1715-1717.
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