Rupture of the extensor tendon of the finger (mallet finger)

Author of the article: Eduard Svitich - orthopedic traumatologist

Fixation (or immobilization) of the leg is usually carried out using plaster casts and plastic orthoses. Depending on the indications, such leg braces may have the following characteristics:

Be short or long;
Look like an open splint or a closed circular bandage;
Allow walking or movement in the joint;
Make it possible to bandage the surgical wound.

Just 10-15 years ago there was practically no alternative to the usual plaster casts. Today, doctors have comfortable and effective orthoses in their arsenal, which have many advantages over plaster. And to understand the advantages of modern products, it is worth remembering the disadvantages of plaster casts.

Symptoms of tendon avulsion from the distal phalanx

Typically, an extensor injury is not accompanied by severe pain. Sometimes people notice the lack of active extension only after some time.

This is what a dangling fingertip looks like; thanks to its association with a hammer, in English literature it is called a mallet finger. The finger can be straightened with the help of external force quite painlessly, but it cannot do this on its own; it clings to everything and causes inconvenience. There may be swelling and tenderness at the dorsum of the distal interphalangeal joint.

Children's hand restraints

The child’s body is designed in such a way that everything heals very quickly, although help is still needed. The main difference between children's orthoses and adult models is not only the size, but also a lower level of rigidity. After all, the child’s skeletal system is more delicate.

Depending on the severity of the injury, the child is prescribed different types of restraints:

Elastic. It is used to prevent injuries that may occur during active sports activities. An elastic brace is also used in the later stages of rehabilitation, when the child no longer needs to limit the ability to move, but still needs unloading of the muscles and ligaments.
Semi-rigid, which is prescribed in cases where the injury did not result in complications, as well as in the later stages of the child’s recovery.
Hard, which is essentially an analogue of gypsum. When using such a fixator, no movement is absolutely possible, so it is used in cases of complex fractures and operations, dislocations, tissue ruptures, and unstable joints.

Depending on the area in which the orthosis is to be used, there are:

Children's shoulder brace, which is used to fix the joints of the shoulder and elbow.
A children's scarf bandage, resembling a support bag in its appearance, in which the belt is fixed around the child's neck and around the body.
Bandage on the wrist joint for children.
Finger orthoses and others.

Treatment of an extensor tear

According to the recommendations of the American Association of Hand Surgeons, most of these injuries can be treated conservatively, i.e. without surgery. Many different fixators have been proposed for treatment, the main purpose of which is to keep the fingertip in the position of maximum extension or even hyperextension for a long time. For fresh injuries (up to 1 week), this period is 6 weeks, while less efficient patients will have to wear a fixator for 2 months.

I make this, in my opinion, a very convenient and functional retainer from low-temperature plastic.

Old school orthopedists will criticize this orthosis design because it was previously considered necessary to fix the proximal interphalangeal joint in a flexed position. At the present stage of development of hand surgery, we have evidence that this should be done only in the case of the formation of the so-called “swan neck”, i.e. hyperextension in the proximal interphalangeal joint, which happens extremely rarely. Here is an example of conservative treatment started 1 month after injury.

Of course, immediately after removing the lock, the finger looks somewhat extravagant, but it is straight, and no one will argue with that. Without a doubt, the marks from the orthosis will disappear within a day.

Types of hand restraints

There are several classifications of arm orthoses. Let's look at the main ones.

According to the area of fixation of the upper limb:

On the shoulder joint and/or upper third of the shoulder. Relieves the joint capsule and trapezius muscle.
Radiocarpal. A hand orthosis can fix only the wrist or capture it and the thumb, partially limiting the movements of the hand.
On the elbow joint. Immobilizes the humerus, ulna and radius.
On the phalanges of the fingers. If you have a fracture or other injury to your finger, you also need to wear a brace on it. Incorrect fusion of bones or the formation of constrictions between tendons will lead to deformation of the phalanges. The result is impaired hand functionality.

According to production features:

Ready. Manufactured in large quantities according to a specific design. They differ in size and color. Can be bought at a pharmacy.
Individual. Manufactured in small batches or in single copies. Measurements taken from the patient are taken into account. Ideally reproduce the anatomical features of a particular person’s limb. The main disadvantage is the very high price.

There is an alternative option - arm orthoses made of thermoplastic material. When heated, it becomes flexible and easily “grabs” the hand, repeating all the bends. Produced in small batches. Can be purchased from private companies and medical equipment stores. The main advantages are a lightweight and comfortable orthosis at an affordable price.

According to the degree of fixation, orthoses are divided into:

Soft. They do not hinder the movements of the joints, but only slightly support the bones, muscles and tendons, preventing them from being damaged under load.
Semi-rigid. Moderately block joints, preventing sudden movements. Such models have special inserts (rings, plates, spokes) made of metal and plastic.
Tough. An arm splint is used for complete immobilization of a joint and/or limb during fractures, ligament ruptures and recovery after operations.

Among the materials for the manufacture of orthoses, the most common are cotton, elastane, neoprene, spandex, metal alloys, polymers, etc.

ORTHOPEDIST-TRAUMOTOLOGIST

During inflammation, after injuries and operations, the affected hand swells. As you recover, the swelling subsides and the orthosis no longer fits the limb so tightly. During treatment, several orthopedic products are replaced in order to adequately distribute the load on the damaged area of the musculoskeletal system.

ORDEKT orthoses are made of thermoplastic material. When heated, it easily changes its shape, thanks to which the orthopedic traumatologist can easily fix the orthosis on the arm in a few minutes. The patient only needs one product for the entire treatment period, as it quickly remodels. The heat-sensitive plastic arm cast can be removed, reheated, and reapplied to secure it more tightly. This saves both time and money for the patient.

When is surgery needed for extensor avulsion?

Despite the fact that even conservative treatment delayed for months gives good results, sometimes surgery is still performed for such an injury. The indications are as follows:

Avulsion of a bone fragment greater than 30% of the width of the articular surface.
Subluxation of the distal phalanx towards the palmar side.
The patient has no hope for a good result of conservative treatment (bad experience, lack of persuasiveness of the doctor, reluctance to wear a retainer for a long time).
The injury is more than 3 months old, although Medscape gives six months.

How does a bunion bandage work?

The principle of operation of the bandage is to move the big toe away from the foot. To prevent slipping and displacement, the device is attached to the metatarsus. During wearing, the unpleasant symptoms accompanying hallux valgus disappear:

pain in the bone and finger caused by tissue deformation, joint inflammation and swelling;
a “bump” on the finger that decreases in size;
feeling of constant muscle fatigue, pain, swelling, aches. Patients begin to remember the long-forgotten lightness in their legs;
corns, calluses, abrasions and other skin manifestations of deformation;
stagnation of blood and lymph in the legs.

Some time after the start of treatment, it becomes possible to wear open sandals and shoes.

Indications for the use of a bandage on the toe from the bunion

Valgus deformity of the feet with the growth of a bone on the leg.
Transverse flatfoot without the appearance of “bumps”. In this case, the bandage is used as a prophylactic agent.
Pain in the metatarsophalangeal joints of the legs.
Hammer-shaped deformity of the fingers with their bending upward.

To achieve a quick effect, you need to start treatment as early as possible. The sooner this happens, the better the result will be. Therefore, the bandage should be worn at the first signs of pathology.

Advantages and disadvantages

The device is simple and easy to use. The bandage is used in emergency situations as a means of temporary immobilization.

The use of an orthosis allows you to reduce the time required for wound treatment. When twisted tightly, the product can replace a hemostatic tourniquet.

Disadvantages include low fixation strength of the device and fragility.

Rules and technique of overlay

There are no clear and strictly defined medical criteria for the use of a bandage. The list of requirements that must be taken into account when using first aid includes:

Sterility of the material.
Strength and elasticity of the fabric.
Correct position of the angle of the bandage (in the uninjured area of the arm).
The product should not put excessive pressure on the hand or squeeze the blood flow.

There are two options for applying a bandage: on an open wound and on a closed injury. Damaged skin is pre-treated with an antiseptic, dried and bandaged with a sterile bandage.

To prevent pinching of the skin and hair on the neck, soft material is placed under the bandage.

From a scarf

The piece of fabric is folded diagonally to form a triangle. The size of the scarf is determined by the purpose of use and depends on the height and constitutional characteristics of the victim. Excess material is trimmed or tucked in. The material must be elastic and resilient.

From a bandage

Used for prophylactic purposes or in the postoperative period. The bandage provides partial immobilization for dislocated joints and isolation of open wounds from external influences.

Correctors for hammertoes: which ones to choose?

Hammertoe deformity is when one or more toes are bent. They acquire a bent position, becoming very similar to a hammer. The disease can spread to all toes except the big toe. The second finger is most susceptible. The second hammertoe is bent, there is little room for it in the shoe, and deformation of the joint begins. The ball of the foot hurts, and corns of various sizes appear on the sole.

REASONS FOR DEFORMATION OF THE TOES:

Wearing tight, narrow shoes
Frequent wearing of high heels
The presence of a congenital predisposition, a long second toe. If it is longer than the big one, then there is a high probability of developing hammertoe deformity
Damage to the leg muscles, nerve endings of the foot or lower leg
Inflammatory processes in the foot, development of rheumatoid arthritis with complications
Transverse flatfoot

MEASURES AIMED AT TREATING HAMMER FINGERS
The fingers themselves do not straighten, and over time the disease can only worsen. In the early stages, the disease can be cured with therapeutic measures. In advanced cases, surgery is needed.

Therapeutic measures aimed at correcting finger deformities:

Wearing orthopedic correctors for toes, which normalize the position of deformed toes

Massage the toes and entire foot to improve blood circulation in the feet. To help you - massage mats, massage slippers, various foot massagers. The most important thing is not to be lazy!

Wearing comfortable anatomical shoes of increased comfort with an orthopedic insole that provides the foot with an anatomical position (supports the transverse and longitudinal arches)

TOP 3 orthopedic correctors for the treatment of hammertoe and claw deformities

Orthopedic correctors for one or two fingers - normalize the position of deformed fingers, reduce the load on the heads of the metatarsal bones, and reduce the risk of corns.

Fabric-coated silicone tube protects the soft tissue of the toes from excessive shoe pressure.

Interdigital partitions (separators) provide a natural arrangement of the toes and, thanks to this, the correct position of the foot when walking; with the help of the partition it is possible to correct hammertoe syndrome

WHERE TO BUY CORRECTORS FOR FOOT AND TOES

The Salamat network of orthopedic salons has a large assortment of foot correctors for hammertoes. Experienced sales consultants will select the correct corrector model for you.

Taking care of your family, the network of orthopedic salons "Salamat"

How to put on a bandage to correct a bunion

The device is worn at night on clean feet without socks. The bandage kit is removed from the package, which contains two devices, designated by the letters “R” - right and “L” - left.

The thumb is inserted into the device so that the soft pad adheres to its surface. After this, the belt is secured around the metatarsus and tightened along the leg.

A correctly tightened design will noticeably move the finger without causing pain. You should go to bed with the brace on, as these devices are not designed to be worn or walked on.

Contraindications

Severe deformation of the joint and fingers, which cannot be corrected with a bandage. In this case, it is better to have surgery immediately.
The presence of abrasions, wounds, stitches, ulcers and other tissue damage in the area where the bandage is worn.
Fungal or infectious infection of the skin of the feet.
Tendency to rapid formation of ulcers on the legs in diabetes mellitus.
The appearance of a “bump” on the leg caused by rheumatism, gout, salt deposits and other pathologies. In this case, it is necessary to treat the underlying disease.