It's been six months since I got hit by a flying baseball and ended up with a permanently bent tip of the index finger (despite wearing a splint day and night since the accident). I've seen other people with bent finger tips but never knew this is how you get them. I'm wondering if there is some kind of surgery that could fix this -- if for no other reason than cosmetics (I don't like how it looks). What can you tell me?
Most mallet finger injuries are treated with splinting, which is what it sounds like you have already tried quite faithfully. Surgery is reserved for those patients who still have the mallet finger deformity (tip of the finger remains bent and cannot be straightened voluntarily) several months after splint immobilization.
There are several different ways to address the problem surgically. Most take care of the ruptured and scarred end of the tendon where it was torn away from the distal interphalangeal (DIP) joint.
Some of the procedures include plication (surgical tucking) of the distended tendon, repair with a tendon graft, threading a strip of the lateral band into the bone at the tip of the finger, and central slip tenotomy (splitting the tendon to adjust the tension on the bone).
There is also a technique known as the Thompson procedure, which addresses the need to reconstruct the spiral oblique retinacular ligament (SORL). This makes it possible for motion of both the distal and proximal interphalangeal joints (DIP and PIP) to work together creating coordinated flexion and extension of the finger.
The Thompson procedure uses a graft from the palmaris longus tendon. The graft tendon is split, spiraled under and over the middle bone of the finger, and then tied over the skin with an external button. A major benefit of the Thompson procedure is that it corrects the extension lag of the tip of the finger (when you can't fully extend the finger tip) while also addressing a bend in the middle joint (proximal interphalangeal (PIP) joint).
If splinting was unsuccessful for you, make a follow-up appointment with your surgeon and let him or her know your desire to continue treatment. Loss of function is one reason to pursue additional treatment but appearance is also important.
Kohei Kanaya MD, et al. The Thompson Procedure for Chronic Mallet Finger Deformity. In The Journal of Hand Surgery. July 2013. Vol. 38A. No. 7. Pp. 1295-1300.
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