hello my name is Helen I'm the extended
physiotherapist practitioner working in
the minor injuries at Leicester Royal
Infirmary this is dr. Shahid and the
associate specialist also work in the
minor injuries and we're here to show
you how to initially manage a patient
who has a mallet finger injury and to
apply the management yes when the
patient arrives ended once you have
diagnosed mallet finger patient will
require always x-ray in ABN that review
if there is a smaller version of the
base of the distal phalanx then the
applying mass field is appropriate and
this patient should be followed up in
review clinical however if there is a
big bony fragment more than 50% that
patients would still require Mouse
splint but the reference should be made
to French clinic for further management
so if we use miss dr. Shaheed as a
patient and he has injured in right
middle finger with a mallet finger
injury and with a mallet finger injury
there is damage to the extensor tendon
on the finger at the DI P joint it can
just be the extensor tendon or it can be
an avulsion fracture at the bony
insertion of the distal phalanx but
presents with flexion at the DI P joint
what we need to be able to do is keep
this finger joint in extension for eight
weeks in an attic splint so if we can
extend the finger I'm going to get you
to pop it down onto the table
so it's important as we are applying the
splint to keep the finger into extension
here we have a box of mallet splints of
all different sizes from size one to
size six so we can just show you the
differences in size obviously it's
important to find the right size to fit
the finger appropriately and for dr.
Shaheed middle finger we have found that
size two is the right size we will just
check that by placing the mallet splint
over the distal end of the finger and
you can see that the shape of the splint
holds the di P joint in extension it is
important that the splint does not cover
the CIP joint as we do need to have
section of that joint
when the splint is fully applied however
in the application of management
sometime to a little finger our index
finger the p IP joint is covered and we
cannot move the VIP joint in that case
we will have to cut the mallet splint
and improvise it we can remove it and we
can cut with the scissor
and in order to make the other smooth
just you have to apply the last last
tape around the edges so that the finger
is not traumatized with the splint edges
and thus is not smooth and you can apply
now and here it is we have improvised um
we are going to provide the splint and
patient well move the PAP got the splint
here is made out of plastic and it does
have some air holes and to allow
breathing of the skin the often patients
return having worn a splint for a number
of weeks with soft white and skill areas
and because of the perforation of the
skin inside the splint because of that
it's quite useful to use a piece of
gauze between the skin and the splint if
we just cut
thin piece of gauze lay it over the top
of the finger to protect the skin and
then the splint should slide nicely on
the top you can see here the p i-- p
joint is kept free flex and then using
things oxide tape or micro pause the
splint can be taped at its base just to
hold the base of the splint on to the
finger if you just hold your hand up
like this please so we can see that the
di p joint is held in extension that we
can flex at the VIP joint and once the
splint is applies we do have an advice
leaflet on mallet finger injury that we
would provide to the patient the patient
will be kept in the splint for eight
weeks so it advised the patient that you
are going to keep this on in total for
eight weeks after four weeks we would
like to see you again
in our review clinic we will give you an
appointment and we will just look at the
skin condition and advise you on further
care of your finger during the first
four weeks we would like to take the
splint off on a daily basis to clean
your finger so to clean your finger I'll
show you on the other hand you're going
to remove the splint keeping the finger
straight on a table then if you hold the
end of your finger you want to use this
one to hold the end of your middle
finger on that hand and you would take
your hand to your sinks holding the end
of your finger place your fingers down
in the sink and the bottom of the sink
and then you can put water on so wash
your finger and remember to hold the end
again by lifting it up again take your
hand back to a table where you can rest
it back down in extension relaxed on a
table and dry your skin okay you can
stay there for a few minutes to let the
air dry the skin also before reapplying
the splint in the same manner as we have
first a drive so at eight weeks
post-injury the patient will return
again to the review clinic where we
hopefully will fully remove the sling so
if we can do you want to take the splint
off yourself it's sometimes easier to
remove the tape yourself
so initially still remembering to keep
the di p joint in extension so lay a
finger flat and we'll take off the
splint and at this point in time we are
now looking to see have we got healing
and can the VIP joint maintain extension
on its own so if I ask you with your
index finger to lift your finger up off
the table if I hold the mid phalanx and
I'm going to push on to the distal
phalanx you're going to maintain the
position hook so hold it in extension
which he can obviously maintain this is
the test I am going to do for the
injured finger so if you can lift the
middle finger and if you can keep the
distal phalanx straight as I apply a
small amount of pressure and you can
obviously maintain extension but pop it
back down if that is the case this is
obviously good news and we would like to
remove the sling completely and now need
to complete comments finger flexion at
this joint so we'll ask the patient to
turn their hand over and using their
other hand if they pop the thumb
underneath the DI P joint crease and
just actively flex the tip of the finger
we do not want you to be pulling the
finger into flexion such as active
flexion and then ask them to bring the
whole finger flex that all joints as
best possible down to the palm and then
fully straighten and this will start
their flexion rehabilitation and should
when you test the expensive mechanisms
the resistance there's a slight
extension lag so they're not held in
full extension this does not mean you
cannot remove the
in the splint can still be removed and
we still need to start commencing
flexion exercises I've explained earlier
if the patient is stiff or wheat in the
joint they can then be referred to hand
physiotherapy service so that was a
quick demonstration for you applying a
Malick splint for a finger injury and if
you have any further questions or
further information do not hesitate to
ask somebody in the minor injury
department