Mallet Finger — বাংলা Clinical Note
সতর্কতা: Mallet finger-এর প্রধান চিকিৎসা হলো DIP joint splinting। ওষুধ tendon/joint deformity ঠিক করে না; ওষুধের কাজ হলো pain, swelling, wound infection risk কমানো। Closed uncomplicated mallet finger-এ antibiotic লাগে না।
1) Definition / সংজ্ঞা
Mallet finger হলো আঙুলের শেষ জয়েন্ট DIP joint-এর extensor tendon injury, যার ফলে আঙুলের ডগা নিচের দিকে ঝুলে থাকে এবং রোগী নিজে থেকে fingertip সোজা করতে পারে না।
এটি baseball finger / drop finger নামেও পরিচিত। Injury tendon rupture হতে পারে, অথবা tendon-এর সাথে distal phalanx-এর ছোট bone fragment উঠে আসতে পারে—এটিকে bony mallet finger বলা হয়।
2) Causes / Etiology — কারণসমূহ
A. Common traumatic causes
- Ball injury / sports injury
ক্রিকেট, ফুটবল, basketball, volleyball—বল fingertip-এ লাগলে extended finger হঠাৎ flex হয়ে যায়। - Forceful flexion of extended fingertip
আঙুল সোজা থাকা অবস্থায় ডগায় direct force লাগলে terminal extensor tendon ছিঁড়ে যায়। - Jammed finger
দরজা, টেবিল, খেলাধুলা বা পড়ে গিয়ে fingertip jam হলে হতে পারে। - Cut injury / laceration over DIP joint
আঙুলের dorsal side-এ কাটা লাগলে extensor tendon সরাসরি কেটে যেতে পারে। এটি open mallet injury—urgent referral দরকার। - Crush injury
ভারী কিছুতে fingertip চাপা পড়লে tendon + bone + nail bed injury একসাথে হতে পারে।
B. Bony cause
- Avulsion fracture of distal phalanx
Terminal extensor tendon distal phalanx থেকে bone fragment সহ ছিঁড়ে যায়।
C. High-risk situation
- শিশু বা adolescent-এ distal phalanx physis involvement থাকলে Seymour fracture mimic করতে পারে—এটি missed হলে infection/deformity risk বেশি।
3) Pathophysiology — কীভাবে deformity হয়
DIP joint সোজা করার জন্য terminal extensor tendon distal phalanx-এর base-এ attach থাকে। Injury হলে tendon আর distal phalanx টানতে পারে না। ফলে FDP tendon-এর flexion force unopposed থাকে এবং fingertip flexed অবস্থায় ঝুলে যায়।
Untreated থাকলে extensor mechanism imbalance হয়—DIP flexion + PIP hyperextension তৈরি হয়ে swan-neck deformity হতে পারে।
4) Symptoms / Clinical Features — লক্ষণসমূহ
- আঙুলের ডগা নিচের দিকে ঝুলে থাকা
DIP joint flexed posture-এ থাকে। - নিজে থেকে fingertip সোজা করতে না পারা
রোগী active DIP extension করতে পারে না, কিন্তু examiner passive extension করলে সাধারণত সোজা হয়। - DIP joint-এর dorsal side pain
আঙুলের শেষ জয়েন্টের পেছনে ব্যথা থাকে। - Swelling / bruise
DIP joint-এর চারপাশে ফোলা, লালচে বা নীলচে bruising থাকতে পারে। - Tenderness at base of distal phalanx
distal phalanx dorsal base-এ চাপ দিলে ব্যথা হয়। - Bony mallet হলে বেশি pain + swelling
fracture fragment থাকলে pain, swelling ও tenderness বেশি হতে পারে। - Open injury হলে wound / bleeding / tendon exposure
কাটা ক্ষত থাকলে infection risk থাকে এবং specialist review জরুরি।
5) Clinical Diagnosis — Clinically কীভাবে diagnosis করবেন
History
- Injury mechanism: ball hit, jammed finger, door crush, cut injury।
- Time since injury: acute <4 weeks, chronic >4 weeks।
- Dominant hand, occupation, sports demand।
- Open wound আছে কি না।
- Previous finger deformity বা arthritis আছে কি না।
Examination
- Look: DIP flexion deformity, swelling, bruising, nail-bed injury।
- Feel: dorsal DIP tenderness।
- Move:
- Active DIP extension absent or weak।
- Passive DIP extension usually possible।
- PIP movement check করতে হবে।
- Neurovascular status: capillary refill, sensation।
- Skin check: splint লাগানোর আগে wound/skin condition দেখবেন।
- Red flags:
- Open wound
- Passive extension impossible
- DIP joint subluxation
- Severe rotational deformity
- Child with physeal injury suspicion
Clinical diagnosis মূলত fingertip droop + loss of active DIP extension দেখে করা হয়; X-ray করা হয় fracture ও joint alignment দেখার জন্য।
6) Investigations — Specific tests
1. Plain X-ray of affected finger — mandatory
Views:
- AP view
- True lateral view
- Oblique view
X-ray-তে দেখবেন:
- Dorsal avulsion fracture আছে কি না
- Fragment কত % articular surface involve করেছে
- DIP joint congruent কি না
- Volar subluxation আছে কি না
- Growth plate injury আছে কি না—children/adolescent
BSSH ও emergency hand guidelines অনুযায়ী suspected mallet injury-তে X-ray করা উচিত, কারণ bony involvement ও joint alignment management change করতে পারে।
2. Ultrasound / MRI
Routine লাগে না। শুধু doubtful tendon rupture, chronic case, medico-legal uncertainty, or surgical planning-এ consider করা যায়।
3. Blood test
Closed mallet finger-এ CBC/CRP লাগে না। Open infected wound হলে CBC, CRP, wound culture করা যেতে পারে।
7) Differential Diagnosis
- DIP dislocation
- Distal phalanx fracture without tendon avulsion
- Seymour fracture in children
- Jersey finger—FDP rupture; এখানে DIP flexion করতে পারে না
- Central slip injury / boutonnière deformity
- Rheumatoid deformity
- Trigger finger নয়—কারণ trigger finger locking হয়, fingertip droop নয়
8) Complications — রোগের জটিলতা
- Permanent extensor lag
চিকিৎসা না করলে fingertip পুরোপুরি সোজা নাও হতে পারে। - Swan-neck deformity
DIP flexion deformity থেকে extensor mechanism imbalance হয়; পরে PIP hyperextension হয়ে আঙুলের shape বদলে যায়। - DIP joint stiffness
ভুলভাবে immobilization বা delayed rehab হলে joint stiff হয়ে যেতে পারে। - Chronic pain / tenderness
বিশেষ করে bony mallet বা arthritis হলে pain persist করতে পারে। - DIP osteoarthritis
untreated bony mallet বা articular incongruity থাকলে পরে osteoarthritis হতে পারে। - Skin maceration / pressure sore from splint
splint খুব tight বা wet থাকলে skin breakdown হতে পারে। - Nail deformity / infection
crush injury বা open injury থাকলে nail-bed complication হতে পারে।
Untreated mallet finger-এ osteoarthritis ও swan-neck deformity documented complication।
9) Management / Treatment — Guideline-based
A. Immediate first aid
- Finger ring থাকলে খুলে ফেলুন।
- Ice pack 10–15 মিনিট করে দিনে কয়েকবার।
- Hand elevation।
- DIP joint flex করতে দেবেন না।
- Temporary splint দিয়ে fingertip straight রাখুন।
- Same day X-ray করুন।
B. Non-operative treatment — main treatment
Indication
- Closed soft tissue mallet finger
- Small bony avulsion without DIP subluxation
- Passive DIP extension possible
- No large displaced fragment
Splinting method
- DIP joint full extension বা slight hyperextension-এ splint
- PIP joint free রাখতে হবে—PIP movement চলবে।
- Splint 24 hours/day রাখতে হবে।
- Cleaning-এর সময়ও DIP flex হতে দেওয়া যাবে না।
- একবার DIP flex হয়ে গেলে healing disrupt হতে পারে এবং splinting period restart করতে হতে পারে।
Duration
- Soft tissue mallet: continuous splint 8 weeks
- Bony mallet: continuous splint about 6 weeks
- এরপর night splint 2–6 weeks, especially activity/sports-এর সময়।
BSSH/CUH/AAOS sources অনুযায়ী most mallet finger splinting দিয়ে treat হয়; splint continuous 6–8 weeks রাখা হয় এবং DIP joint না বাঁকানো অত্যন্ত গুরুত্বপূর্ণ।
C. Surgical referral indications
Urgent hand surgery / orthopaedic referral যদি থাকে:
- Open mallet injury
- Large avulsion fracture, সাধারণত >30–33% articular surface
- Volar subluxation of distal phalanx
- DIP joint incongruity
- Passive extension impossible
- Failed splinting
- Chronic symptomatic mallet deformity
- Children with suspected physeal injury
BSSH treatment standards large >1/3 articular fracture ও subluxation concern থাকলে careful assessment/surgical pathway recommend করে।
10) Pharmacological Treatment — Bangladesh prescription-style drug list
Important: Closed mallet finger-এ routine antibiotic/steroid লাগে না। নিচের dose adult general dose; renal disease, liver disease, pregnancy, PUD, anticoagulant use, asthma, HTN, CKD থাকলে dose/choice পরিবর্তন করতে হবে।
1. Paracetamol
Generic name: Paracetamol / Acetaminophen
Therapeutic category: Analgesic, antipyretic
Pharmacological class: Para-aminophenol derivative; non-opioid analgesic
Purpose / কেন used হয়: Mild to moderate pain control; NSAID contraindicated হলে safer first-line analgesic।
Adult dose: 500 mg–1 g orally every 6–8 hours PRN
Maximum: সাধারণত 4 g/day; liver disease/alcohol use/low body weight হলে lower maximum।
Duration: 2–5 days PRN; pain থাকলে review।
Bangladesh available brand examples from MedEx:
- Napa 500 mg tablet — Paracetamol — Beximco Pharmaceuticals
- Ace 500 mg tablet — Paracetamol — Square Pharmaceuticals
- Fibi 500 mg tablet — Paracetamol — MST Pharma
- G-Paracetamol 500 mg tablet — Gonoshasthaya Pharma Ltd.
MedEx-এ Napa/Ace 500 mg pain/fever indications এবং multiple 500 mg paracetamol brands listed আছে।
Side effects:
- Nausea, rash—rare
- Overdose হলে hepatotoxicity
- Chronic high dose হলে liver injury risk
Drug interactions:
- Warfarin-এর সাথে prolonged regular use INR বাড়াতে পারে
- Alcohol/chronic liver disease hepatotoxicity risk বাড়ায়
- Enzyme inducers—rifampicin, carbamazepine, phenytoin—liver toxicity risk বাড়াতে পারে
2. Ibuprofen
Generic name: Ibuprofen
Therapeutic category: Analgesic, anti-inflammatory
Pharmacological class: NSAID; non-selective COX inhibitor
Purpose / কেন used হয়: Pain + inflammation + swelling কমাতে short course।
Adult dose: 200–400 mg orally every 6–8 hours after food
Maximum OTC-type: 1200 mg/day; physician-supervised dose ভিন্ন হতে পারে।
Duration: 3–5 days; prolonged use avoid unless indicated।
MedEx ibuprofen adult dose 200–400 mg single dose or 3–4 times/day, 6-hour interval এবং max 1200 mg/day উল্লেখ করে।
Bangladesh available brand examples from MedEx:
- Flamex 200 mg / 400 mg tablet — ACI Limited
- Profen 400 mg tablet — ACME Laboratories
- Intaflam 400 mg tablet — Incepta Pharmaceuticals
- Reumafen 200 mg / 400 mg tablet — Beximco Pharmaceuticals
- G-Ibuprofen 400 mg tablet — Gonoshasthaya Pharma
MedEx ibuprofen brand listে এগুলো 200–400 mg strengths সহ listed আছে।
Side effects:
- Gastritis, dyspepsia, peptic ulcer, GI bleeding
- Renal impairment
- Fluid retention, BP rise
- Bronchospasm in NSAID-sensitive asthma
- Rash
Drug interactions:
- Warfarin/DOAC/aspirin/clopidogrel → bleeding risk
- ACE inhibitor/ARB + diuretic → AKI risk
- Steroid/SSRI → GI bleeding risk
- Lithium/methotrexate → toxicity risk
- Other NSAID-এর সাথে একসাথে দেওয়া যাবে না
3. Naproxen Sodium
Generic name: Naproxen sodium
Therapeutic category: Analgesic, anti-inflammatory
Pharmacological class: NSAID; propionic acid derivative
Purpose / কেন used হয়: Longer-acting NSAID; pain ও inflammation control।
Adult dose: 250–500 mg orally twice daily after food
Duration: 3–5 days; persistent pain হলে reassess।
Bangladesh available brand examples from MedEx:
- Naproxin 250 mg / 500 mg tablet — Ambee Pharmaceuticals
- Napryn 250 mg / 500 mg tablet — Healthcare Pharmaceuticals
- Naproxen 500 mg tablet — Novatek / Guardian / Amico
- Naprox 125 mg/5 ml suspension and 10% gel — Eskayef
MedEx naproxen sodium brand listে 250 mg, 500 mg tablet, suspension ও gel forms listed আছে।
Side effects:
- Gastritis, ulcer, GI bleeding
- Renal impairment
- Dizziness
- BP rise/fluid retention
- Photosensitivity—rare
Drug interactions:
- Anticoagulants/antiplatelets → bleeding
- ACEI/ARB/diuretic → renal injury
- Lithium/methotrexate → toxicity
- Other NSAIDs avoid
- Steroids/SSRIs → GI bleeding risk
4. Diclofenac Sodium
Generic name: Diclofenac sodium
Therapeutic category: Analgesic, anti-inflammatory
Pharmacological class: NSAID; phenylacetic acid derivative
Purpose / কেন used হয়: Acute traumatic pain/swelling কমাতে; GI/CV risk বিবেচনা করে short course।
Adult dose: 50 mg orally 2–3 times daily after food
Duration: 2–5 days; long course avoid।
Topical option: Diclofenac gel 1% locally 2–4 times/day for 3–5 days, intact skin only।
Bangladesh available brand examples from MedEx:
- Diclofen 50 mg tablet — Opsonin Pharma
- Diclorex 50 mg tablet, 75 mg/3 ml injection — Medimet
- Fengel 1% gel / 50 mg tablet — Pharmadesh
- Penac 50 mg tablet — APC Pharma
- Ultrafen SR 100 mg — Beximco
MedEx diclofenac listে 50 mg tablet, SR 100 mg, injection 75 mg/3 ml এবং 1% gel forms listed আছে।
Side effects:
- Gastritis, ulcer, GI bleeding
- Raised BP, edema
- Renal impairment
- Increased cardiovascular risk, especially high dose/long-term
- Liver enzyme elevation
Drug interactions:
- Anticoagulants/antiplatelets → bleeding
- ACEI/ARB/diuretics → AKI risk
- Methotrexate/lithium → toxicity
- Steroid/SSRI → GI bleed
- Other NSAIDs avoid
5. Aceclofenac
Generic name: Aceclofenac
Therapeutic category: Analgesic, anti-inflammatory
Pharmacological class: NSAID; diclofenac analogue
Purpose / কেন used হয়: Pain + inflammation relief in trauma-related soft tissue pain।
Adult dose: 100 mg orally twice daily after food
Duration: 3–5 days।
Bangladesh available brand examples from MedEx:
- Flexi 100 mg tablet — Square Pharmaceuticals
- Ceclofen 100 mg tablet — Renata
- Celofen 100 mg tablet — ACI
- Clof 100 mg tablet — Biopharma
- Dolonac 100 mg tablet — Cosmic Pharma
MedEx aceclofenac indication pain/inflammation relief এবং বহু 100 mg brand list করে।
Side effects:
- Dyspepsia, abdominal pain
- GI bleeding/ulcer
- Dizziness
- Renal impairment
- Edema, BP rise
Drug interactions:
- Warfarin/DOAC/antiplatelets → bleeding
- ACEI/ARB/diuretic → AKI
- Lithium/methotrexate → toxicity
- Steroid/SSRI → GI bleeding
- Other NSAIDs avoid
6. Etoricoxib
Generic name: Etoricoxib
Therapeutic category: Analgesic, anti-inflammatory
Pharmacological class: Selective COX-2 inhibitor NSAID
Purpose / কেন used হয়: NSAID প্রয়োজন কিন্তু GI intolerance বেশি হলে sometimes used; তবে CV risk বিবেচনা জরুরি।
Adult dose: 60 mg once daily or 90 mg once daily for short-term acute pain; lowest effective dose।
Duration: 2–5 days।
Bangladesh available brand examples from MedEx:
- Recox 60 mg / 90 mg tablet — Renata
- Powercox 90 mg tablet — Chemist Laboratories
- Ratirex 90 mg tablet — Radius Pharmaceuticals
MedEx etoricoxib brand listে Recox 60/90 mg, Powercox 90 mg, Ratirex 90 mg listed আছে।
Side effects:
- Dyspepsia
- Edema, hypertension
- Renal impairment
- Increased cardiovascular thrombotic risk
- Headache, dizziness
Drug interactions:
- Warfarin/anticoagulants → INR/bleeding risk
- ACEI/ARB/diuretic → renal risk
- Lithium → toxicity
- Rifampicin may reduce level
- Other NSAIDs avoid
7. Pantoprazole — NSAID gastroprotection
Generic name: Pantoprazole sodium
Therapeutic category: Anti-ulcerant
Pharmacological class: Proton pump inhibitor, PPI
Purpose / কেন used হয়: NSAID দিলে gastritis/ulcer risk কমাতে, especially PUD history, elderly, steroid/anticoagulant user।
Adult dose: 20–40 mg once daily before breakfast
Duration: NSAID চলাকালীন 3–7 days; high-risk patient-এ longer as indicated।
Bangladesh available brand examples from MedEx:
- Pantonix 20 mg / 40 mg tablet — Incepta
- Patanix 20 mg tablet — Nipa
- PC-20 20 mg tablet — Central
- Pelican 20 mg tablet — Delta Pharma
MedEx pantoprazole/Pantonix indication includes NSAID-induced ulcer and GERD/peptic ulcer disease।
Side effects:
- Headache
- Nausea, diarrhea/constipation
- Long-term use: hypomagnesemia, B12 deficiency, fracture/infection risk
Drug interactions:
- May reduce absorption of ketoconazole/itraconazole
- Warfarin monitoring may be needed
- High-dose methotrexate toxicity risk—caution
- Clopidogrel interaction is less than omeprazole but caution in high-risk cardiac patients
8. Cephalexin — only if open wound / skin infection risk
Generic name: Cephalexin
Therapeutic category: Antibiotic
Pharmacological class: 1st-generation cephalosporin
Purpose / কেন used হয়: Open laceration, contaminated wound, cellulitis suspicion—skin flora coverage। Closed mallet finger-এ antibiotic নয়।
Adult dose: 500 mg orally every 6 hours; mild SSTI-তে sometimes 500 mg 12 hourly।
Duration: 3–5 days for prophylaxis-type contaminated wound; established infection হলে 5–7 days depending on severity।
MedEx cephalexin adult dose 250–500 mg every 6 hours এবং skin/soft tissue infection-এ 500 mg every 12 hours option উল্লেখ করে।
Bangladesh available brand examples from MedEx:
- Acelex 250 mg / 500 mg capsule — ACME
- Cefalex 500 mg capsule — Drug International
- Cephalen 250 mg / 500 mg capsule — Beximco
- Navalexin 500 mg capsule — Navana
- Neorex 250 mg capsule / suspension — Eskayef
MedEx cephalexin brand listে এগুলো listed আছে।
Side effects:
- Nausea, diarrhea
- Rash, urticaria
- Candidiasis
- Rare: C. difficile diarrhea
- Beta-lactam allergy
Drug interactions:
- Warfarin → INR/bleeding monitoring
- Probenecid increases cephalexin level
- Live typhoid vaccine efficacy কমতে পারে
- Severe penicillin allergy থাকলে caution
9. Flucloxacillin — open wound / staphylococcal skin coverage
Generic name: Flucloxacillin sodium
Therapeutic category: Antibiotic
Pharmacological class: Penicillinase-resistant penicillin / anti-staphylococcal penicillin
Purpose / কেন used হয়: Staphylococcal skin/soft tissue infection, open dorsal wound, cellulitis suspicion।
Adult dose: 500 mg orally 6 hourly, preferably before food
Duration: 5 days; severity অনুযায়ী 5–7 days।
NHS adult dosing 250–500 mg four times daily উল্লেখ করে; MedEx flucloxacillin gram-positive/penicillinase-producing organism infection indication দেয়।
Bangladesh available brand examples from MedEx:
- Flupen 250 mg / 500 mg capsule — Drug International
- Flustaph 250 mg / 500 mg capsule — Orion Pharma
- Flustar 250 mg / 500 mg capsule — Renata
- Flux 250 mg / 500 mg capsule, 500 mg/vial injection — Opsonin
- Fluking 250 mg / 500 mg capsule — Chemist Laboratories
MedEx flucloxacillin brand listে এগুলো listed আছে।
Side effects:
- Nausea, diarrhea
- Rash, allergy/anaphylaxis
- Cholestatic hepatitis—rare but important
- C. difficile diarrhea—rare
Drug interactions:
- Warfarin → INR variation possible
- Methotrexate clearance reduce হতে পারে
- Oral contraceptive interaction clinically uncommon, but vomiting/diarrhea হলে backup contraception
- Penicillin allergy contraindication
10. Amoxicillin + Clavulanic Acid — contaminated/crush/open wound option
Generic name: Amoxicillin + Clavulanic acid
Therapeutic category: Antibiotic
Pharmacological class: Aminopenicillin + beta-lactamase inhibitor
Purpose / কেন used হয়: Contaminated wound, bite/crush injury, mixed flora risk; closed mallet finger-এ routine নয়।
Adult dose: 625 mg orally every 8–12 hours after food, or 1 g/875+125 mg every 12 hours depending on formulation/severity।
Duration: 3–5 days prophylaxis; infection হলে 5–7 days or according to response।
Bangladesh available brand examples from MedEx:
- Tyclav 250+125 mg / 875+125 mg tablet — Beximco
- Bioclavid 250+125 mg tablet — Sandoz
- Fimoxyclav 250+125 mg / 875+125 mg tablet, suspension, injection — Synovia
- Clacido IV 500+100 mg / 1 g+200 mg — Healthcare
MedEx amoxicillin+clavulanic acid brand listে Tyclav, Bioclavid, Fimoxyclav, Clacido forms listed আছে।
Side effects:
- Diarrhea common
- Nausea, vomiting
- Rash
- Cholestatic jaundice/hepatitis—rare
- C. difficile diarrhea—rare
Drug interactions:
- Warfarin → INR increase risk
- Methotrexate → toxicity risk
- Allopurinol → rash risk
- Oral contraceptive failure mainly if vomiting/diarrhea occurs
11. Tetanus vaccine — open injury prevention
Generic name: Adsorbed tetanus vaccine / Tetanus toxoid vaccine
Therapeutic category: Vaccine
Pharmacological class: Toxoid vaccine
Purpose / কেন used হয়: Open wound/crush injury/contaminated injury-তে tetanus prevention।
Dose: 0.5 ml IM according to immunization status and wound category।
Duration: Single booster; incomplete immunization হলে schedule অনুযায়ী further doses।
Bangladesh available brand examples from MedEx:
- TTvax 40 IU/0.5 ml IM injection — Popular Pharmaceuticals
- Vaxitet 40 IU/0.5 ml IM injection — Incepta
MedEx tetanus vaccine brand listে TTvax ও Vaxitet 40 IU/0.5 ml listed আছে।
Side effects:
- Injection site pain/swelling
- Fever, malaise
- Rare hypersensitivity
Drug interactions / cautions:
- Immunosuppressive therapy vaccine response কমাতে পারে
- Anticoagulant patient-এ IM injection bleeding/hematoma caution
- Severe previous allergic reaction থাকলে specialist advice
11) Bangladesh doctors commonly কী prescribe করেন — practical list
Closed uncomplicated mallet finger:
- Splint 24/7 for 6–8 weeks — main treatment
- Paracetamol 500 mg — pain control
- Ibuprofen 400 mg / Naproxen 500 mg / Aceclofenac 100 mg / Diclofenac 50 mg / Etoricoxib 60–90 mg — pain + swelling, short course
- Pantoprazole 20–40 mg / Omeprazole 20 mg — NSAID দিলে gastric protection, especially high-risk patient
- No antibiotic — যদি closed injury হয়
Open mallet finger / laceration / contaminated wound:
- Wound wash + dressing
- X-ray
- Splint
- Cephalexin or Flucloxacillin — skin flora coverage
- Amoxicillin + Clavulanic acid — contaminated/crush/bite-type wound
- Tetanus vaccine ± immunoglobulin — immunization status অনুযায়ী
- Hand surgery referral
12) Prevention — কীভাবে প্রতিরোধ করবেন
- Cricket/volleyball/basketball খেলায় finger protection বা taping ব্যবহার করা।
- Ball catch করার সময় fingertip দিয়ে stop না করে palm position ঠিক রাখা।
- Door/crush injury থেকে সাবধান থাকা।
- Injury হওয়ার পর “সামান্য jammed finger” ভেবে ignore না করা।
- Fingertip droop হলে দ্রুত X-ray + splint।
- Splint ভিজলে বা loose হলে therapist/doctor দিয়ে refit করা।
- Splint খুলে cleaning করার সময় DIP joint এক মুহূর্তও bend করতে না দেওয়া।
- Sports return করার সময় night/activity splint ব্যবহার করা।
- Open wound হলে tetanus status update রাখা।
Overview / Summary
Mallet finger হলো terminal extensor tendon injury, যার ফলে DIP joint flexed থাকে এবং fingertip active extension করা যায় না। Diagnosis mostly clinical, কিন্তু AP/lateral/oblique X-ray mandatory fracture ও subluxation assess করার জন্য। Main treatment হলো continuous DIP extension splinting 6–8 weeks, PIP free রেখে। Medicine শুধু pain/inflammation বা open wound infection prevention-এর জন্য।
Actionable Plan / Steps
- Affected finger-এর X-ray AP, true lateral, oblique করুন।
- DIP joint full extension/slight hyperextension splint দিন; PIP joint free রাখুন।
- Soft tissue হলে 8 weeks, bony হলে 6 weeks continuous splint।
- Pain হলে paracetamol ± short NSAID; NSAID দিলে high-risk patient-এ PPI।
- Open wound হলে wound care + antibiotic + tetanus + urgent hand surgery referral।
- Red flags: open injury, volar subluxation, >30–33% articular fracture, passive extension impossible, child physeal injury suspicion।
Reference List — Textbook + Guideline + DOI
Textbooks
- Green’s Operative Hand Surgery, 8th ed. Chapter: Extensor tendon injuries / Mallet finger.
- Campbell’s Operative Orthopaedics, 14th ed. Chapter: Hand injuries and tendon injuries.
- Apley & Solomon’s System of Orthopaedics and Trauma, latest ed. Chapter: Hand injuries.
Guidelines / Clinical resources
- British Society for Surgery of the Hand. Mallet finger injury patient guidance—X-ray and continuous splinting 6–8 weeks.
- BSSH. Mallet Injuries – Standards for Treatment—DIP extension splinting 24/7, PIP free, referral criteria for large fracture/subluxation.
- AAOS OrthoInfo. Mallet Finger / Baseball Finger—most cases treated with splinting.
- Perth Children’s Hospital ED Guideline. Mallet finger—clinical assessment, AP/oblique/lateral X-ray, referral criteria.
Peer-reviewed journals with DOI
- Lamaris GA, Matthew MK. The Diagnosis and Management of Mallet Finger Injuries. Hand (N Y). 2017;12(3):223–228. DOI: 10.1177/1558944716642763.
- Alla SR, Deal ND, Dempsey IJ. Current Concepts: Mallet Finger. Hand (N Y). 2014;9(2):138–144. DOI: 10.1007/s11552-014-9609-y.
- Lin JS, Samora JB. Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am. 2018;43(2):146–163.e2. DOI: 10.1016/j.jhsa.2017.10.004.
Md.Rafiqul Islam Lipu,Date:-23-06-2026 Tuesday,Time:-11-46-12 Am