Type IIb bony mallet finger: is anatomical reduction of the fracture necessary?

One-third of all mallet fingers are associated with a fracture. Many different management strategies have been described. Some authors recommend nonsurgical management for all mallet fractures. In contrast, others suggest mandatory open reduction and internal fixation for bony mallet injuries with a large displaced dorsal fragment and associated distal interphalangeal (DIP) joint subluxation. We retrospectively studied 3 cases of a mallet fracture with a large displaced dorsal fragment and subsequent DIP joint subluxation managed with closed reduction using only percutaneous pinning of the DIP joint. All 3 patients had satisfactory pain-free and functional clinical outcomes at their particular follow-up (4, 6, or 19 months). Closed reduction and internal fixation of the subluxated joint using only Kirschner wires produced satisfactory outcomes for the 3 type IIb bony mallet fingers. Anatomical reduction of the fracture may be unnecessary in patients such as those in our case series. One aim of this pilot study is to justify larger, prospective studies.