Mallet Finger Treatment: Concerns and Surgical Options - Orthopedics

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Mallet finger, also known as baseball finger, occurs when the extensor tendon at the distal phalanx of a finger is ruptured or avulsed, leading to an inability to extend the fingertip. This condition is often caused by trauma, such as catching a ball or hitting a hard surface. In your brother's case, it seems that he underwent a surgical procedure where the tendon was reattached in a manner that may not align with the standard tendon-to-tendon repair, which is typically preferred for optimal functional recovery.

The surgical approach your brother received, where the tendon was sutured to the skin rather than to itself, is generally reserved for cases where the tendon is severely damaged or when the patient has limited functional demands from that finger. This method may not provide the best outcome in terms of restoring full extension and function, especially if the patient is young and active, as in your brother's case.


Concerns Regarding the Current Surgical Method
1. Functional Impairment: The primary concern with the method used is that it may not restore the full range of motion or strength to the finger. The extensor tendon is crucial for finger extension, and improper alignment or repair can lead to long-term functional deficits.

2. Scar Tissue Formation: Suturing the tendon to the skin can lead to the formation of scar tissue, which may further limit the mobility of the finger. Scar tissue can be less flexible than normal tendon tissue, potentially leading to stiffness and decreased functionality.

3. Risk of Re-rupture: If the tendon is not properly aligned or if the repair is not robust, there is a risk of re-rupture, especially if the finger is subjected to stress or trauma during the healing process.


Surgical Options and Recommendations
If your brother is experiencing significant functional impairment or if there is concern about the integrity of the repair, a second surgical opinion may be warranted. Here are some options to consider:
1. Re-evaluation by a Hand Specialist: A hand surgeon specializing in tendon repairs can assess the current state of the finger and determine if a revision surgery is necessary. They will likely perform a physical examination and may order imaging studies to evaluate the tendon and joint.

2. Tendon-to-Tendon Repair: If the tendon is still viable and there is enough length to perform a proper repair, a tendon-to-tendon surgical repair may be recommended. This method typically involves suturing the ends of the tendon back together, allowing for better functional recovery.

3. Rehabilitation: Regardless of the surgical approach, a comprehensive rehabilitation program is crucial. This may include physical therapy focused on range of motion exercises, strengthening, and functional training to maximize recovery.

4. Non-Surgical Options: If the finger is stable and the function is acceptable, non-surgical management, including splinting and therapy, may be considered. However, this is typically less effective for complete ruptures.


Conclusion
In summary, the surgical method your brother underwent may not provide the best functional outcome, especially given his active lifestyle. It is advisable to consult with a hand specialist who can provide a thorough evaluation and discuss potential surgical options that may yield better results. Early intervention is key in mallet finger cases to ensure optimal recovery and restore function to the affected finger.