What is the most appropriate management strategy for a mallet fracture?

For a mallet fracture, the most appropriate management strategy is to splint the distal interphalangeal (DIP) joint in extension. This type of fracture typically occurs due to an injury that causes the extensor tendon to pull away from the bone along with a piece of the bone itself. The goal of treatment is to ensure that the fracture heals properly while maintaining the joint in an extended position.

When the DIP joint is splinted in extension, it allows the fracture to heal in the correct alignment. This is crucial because if the joint is not held in the correct position, it can lead to complications such as joint stiffness or chronic deformity. The extension splinting should ideally be maintained continuously for several weeks, often for a total of 6 to 8 weeks, depending on the severity of the fracture.

In contrast, surgical options are typically reserved for cases where there is a significant displacement of the fracture or when conservative treatment fails. Buddy taping and applying a cast are not standard practices for mallet fractures, as they may not provide the necessary stability or proper alignment needed for healing. This highlights the importance of appropriate immobilization techniques tailored to the specific injury at hand.