The Direct Tendon Suture and Paratenon Repair Technique for Acute Tendinous Mallet Finger: A Case Series.

(1) Introduction: Tendinous mallet finger is a frequent deformity that occurs after an extensor tendon injury during sports or daily life activities. Despite the existence of numerous non-operative and operative techniques to address this deformity, there is a controversy on its optimal management. In this study, we aimed to present a direct tendon suture technique using the distal interphalangeal (DIP) joint open approach for treating tendinous mallet finger injury. (2) Methods: Between 2019 and 2021, 19 patients with closed non-fracture tendinous mallet fingers underwent the direct tendon and paratenon repair technique. After skin incision, we opened the paratenon with lazy S shape incision and found the ruptured proximal and distal tendon ends. We reapproximated the tendons using a simple interrupted suture with Prolene #6/0. After that, we meticulously performed paratenon repair using PDS #6/0 for preventing readherence. Temporary trans-articular Kirschner wire fixation was used for 4 weeks. (3) Results: All patients were followed-up for 3-8 months (mean: 4.8 months). The mean final extension lag was 6.5 degrees, and the overall rate of cases with excellent and good outcomes using Crawford's criteria was 85%. (4) Conclusions: In conclusion, this surgical approach could be a reliable alternative for the treatment of tendinous mallet finger injuries.

Extensor tendon rupture and preoperative mri confirmations of suture anchor prolapse: a case report and literature review.

BACKGROUND: While suture anchors are widely used in medical procedures for their advantages, they can sometimes lead to complications, including anchor prolapse. This article presents a unique case of suture anchor prolapse at the base of the distal phalanx of the little finger after extensor tendon rupture reconstruction surgery. CASE PRESENTATION: A 35-year-old male, underwent extensor tendon rupture reconstruction using a non-absorbable suture anchor. After seven years the patient visited our outpatients complaining of stiffness, pain, and protrusion at the surgical site. Initial X-ray imaging suggested suggesting either a fracture of the distal phalanx or tendon adhesion but lacked a definitive diagnosis. Subsequent magnetic resonance imaging (MRI) revealed bone connectivity between the middle and distal phalanges with irregular signal shadow and unclear boundaries while maintaining a regular finger shape. MRI proved superior in diagnosing prolapsed suture anchors, marking the first reported case of its kind. Surgical intervention confirmed MRI findings. CONCLUSIONS: Suture anchor complications, such as prolapse, are a concern in medical practice. This case underscores the significance of MRI for accurate diagnosis and the importance of tailored surgical management in addressing this uncommon complication.

Orthotic Intervention with Custom-made Thermoplastic Material in Acute and Chronic Mallet Finger Injury: A Comparison of Outcomes.

Objectives: To compare the effect of using custom-made orthosis on improving extension lag and reducing disability in acute and chronic mallet fingers. Methods: We recruited 51 patients with acute or chronic Doyle type-1 mallet fingers, who were provided with a custom-made thermoplastic anti-mallet finger orthosis to wear full-time for 6 weeks and an additional 2 weeks at nighttime. The primary outcome, extension lag, was assessed at enrollment as well as six- and twelve-week follow-ups. Secondary outcomes included disability and satisfaction, which were evaluated using the Disability of the Arm, Shoulder, and Hand questionnaire at enrollment and 12 weeks, and a satisfaction scale at 12 weeks follow-up. Data analysis was conducted using univariate analysis of variance (ANOVA), one-way repeated measure mixed model analysis of covariance (ANCOVA), and independent sample t-test. Results: A total of 43 participants, 25 acute and 18 chronic mallet fingers, completed the 12-week evaluation. The study found no significant difference between the two groups in terms of improvement in extension lag at either follow-up time point (P=0.21). Disability improved in both the acute and chronic groups at follow-up (P<0.05). Additionally, both groups expressed satisfaction with the treatment outcome, and no statistically significant difference was observed (t=0.173, P=0.51). We could not identify any clinically significant difference between the two groups in regard to extension lag, disability, or satisfaction at follow-up. Notably, 96% of the patients in the acute group and 88% of the patients in the chronic group demonstrated good to excellent outcomes. Conclusion: Orthotic intervention with custom-made thermoplastic material in acute and chronic mallet fingers improved extension lag and disability, and both groups were satisfied with the treatment outcomes. The findings of our study indicated that patients with chronic mallet fingers benefited from orthotic interventions in the same way that patients with acute mallet fingers did.

Retrospective study of Ishiguro's technique for mallet bone finger in children: long-term follow-up and analysis of predictors in outcomes.

PURPOSE: There is no consensus on the optimal treatment of bony mallet finger in the paediatric population due to a lack of studies in children. The Ishiguro technique is simple and less invasive, and treatment with K-wire fixation seems to provide better results for extension lag in bony mallet finger according to the literature. A retrospective cross-sectional study with long-term follow-up was performed to evaluate the functional and clinical outcomes of this method in children. Preoperative and intraoperative predictors of outcome were investigated. METHODS: From June to December 2022, we evaluated 95 children who underwent extension K-wire block from 2002 to 2012. Eighty-four children were included (mean age 14.8 ± 1.68 years) for a mean long-term follow-up of 11.6 ± 2.3 (8-16) years. Clinical and radiographic features were assessed. Pain and functional outcomes were assessed using Crawford criteria, range of motion (ROM) at the distal interphalangeal joint (DIPJ), loss of extension, and VAS scale. Univariate and multivariate regressions were used to assess which variables might predict the worst outcomes at long-term follow-up. RESULTS: Bone union and pain relief were always achieved. There were no complaints of potential growth impairment or nail deformity. 82.1% of patients showed excellent and good results. Fifteen patients had fair results. CONCLUSIONS: Although there are currently no significant differences between surgery and orthosis in adults, the Ishiguro technique is more effective in children when it comes to outcomes in the treatment of mallet fingers. A high percentage of excellent and good results were achieved, and no epiphyseal damage or nail deformity was reported. A strong and significant correlation was found between the worst outcomes and either delayed treatment time or excessive flexion angle.

Customizable Hyperextension Splint for Mallet Finger.

Introduction: Mallet finger is a common deformity occurring due to the traumatic detachment of the extensor tendon at its insertion in the distal phalanx. Despite several different methods of splinting being available, residual extensor lag remains one of the most common complications of conservative treatment. Technique Report: We demonstrate a novel technique to make a hyperextension splint which can be customized as per the individual. The pictorial demonstration depicts every step in the preparation, application, and maintenance of the splint. Conclusion: We believe that the use of such easily accessible materials and visual demonstration of each step, with pointers along the way to verify the correct technique, will empower any medical professional, to satisfactorily treat such injuries at the primary point of contact, without necessitating the services of a hand surgeon.

Incidence and management of mallet finger in Dutch primary care: a cohort study.

BACKGROUND: A mallet finger (MF) is diagnosed clinically and can be managed in primary care. The actual incidence of MF and how it is managed in primary care is unknown. AIM: To determine the incidence of MF in primary care and to obtain estimates for the proportions of osseous and tendon MF. An additional aim was to gain insight into the management of patients diagnosed with MF in primary care. DESIGN & SETTING: A cohort study using a healthcare registration database from general practice in the Netherlands. METHOD: Patients aged ≥18 years with a new diagnosis of MF from 1 January 2015-31 December 2019 were selected using a search algorithm based on International Classification of Primary Care (ICPC) coding. RESULTS: In total, 161 cases of MF were identified. The mean incidence was 0.58 per 1000 person-years. A radiograph was taken in 58% (n = 93) of cases; 23% (n = 37) of cases had an osseous MF. The most applied strategies were referral to secondary care (45%) or conservative treatment in GP practice (43%). Overall, 7% were referred to a paramedical professional. CONCLUSION: On average, a Dutch GP assesses ≥1 patient with MF per year. Since only a minimal number of patients required surgical treatment and a limited number of GPs requested radiography, the recommendation in the guidelines to perform radiography in all patients with MF should potentially be reconsidered. The purpose of requesting radiographs should not be to distinguish between a tendinogenic or osseous MF, but to assess whether there is a possible indication for surgery.

The biomechanical properties of the hook plate and pull-out suture in mallet finger fractures: a cadaveric study.

A total of 32 cadaveric fingers with bony mallet injuries were fixed using either the hook plate or the pull-out suture technique. The purpose of this study was to assess the immediate postoperative biomechanical responses of the fixation techniques under different load conditions. The fingers were cyclically loaded with a force of 7 N for 3500 cycles and until construct failure. The maximum displacements of the hook plate and pull-out sutures were 0.7 mm and 0.6 mm, respectively (p = 0.556). The stiffnesses of the hook plate and pull-out suture were 1.3 N/mm and 1.1 N/mm, respectively (p = 0.515). The ultimate loads-to-failure for the hook plate and pull-out suture were 64.4 N (interquartile range [IQR] 37.7-77.7) and 44.5 N (IQR 29.7-63.5), respectively (p = 0.094). Both fixation techniques were able to withstand immediate postoperative mobilization without any difference in fracture displacement, construct stiffness or maximum load to failure.

Quick and safe: why a k-wire-extension-block-fixation of a bony mallet finger is the favoured treatment.

INTRODUCTION: Mallet fingers are the most common tendon injuries of the hand. Bony avulsion distal finger extensor tendon ruptures causing a mallet finger require special attention and management. In this monocentral study, we analyzed the clinical and individual outcomes succeeding minimal invasive k-wire extension block treatment of bony mallet fingers. MATERIALS AND METHODS: In a retrospective study, we sent a self-designed template and a QUICK-DASH score questionnaire to all patients, who were treated because of a bony mallet finger between 2009 and 2022 and fulfilled the inclusion criteria. A total of 244 requests were sent out. 72 (29.5%) patients participated in the study. Forty-five men and twenty-seven women were included. RESULTS: 98.7% (n = 75) of the cases were successfully treated. Patients were highly satisfied with the treatment (median 8.0; SD ± 2.9; range 1.0-10.0). Based on the QUICK-DASH score, all patients showed no difficulties in daily life. The extent of avulsion did not influence the outcome. CONCLUSION: We conclude that the minimally invasive treatment of a bony mallet finger should be offered to every patient, because it is safe, fast, and reliable. Thus, we propose to perform extension-block pinning independently of the articular area.

Assessment of biomechanical properties of the new two-hole miniplate internal fixation for bony mallet finger treatment by finite element analysis.

Surgery is highly recommended for a bony mallet finger when the fracture fragment involves greater than one-third of the articular surface. K-wire based and plated-based internal fixation are widely used for mallet fracture. However, the outcomes of different surgical treatment options make the treatment of the bony mallet finger controversial due to frequent complications. The two-hole miniplate is a new and promising plate-based internal fixation treatment for the bony mallet finger with low complication rates in recent years. The aim of this study was to evaluate the biomechanical parameters (von Mises stress, strain and deformation) of the two-hole miniplate fixation compared to the traditional K-wire-based fixation using finite element analysis (FEA). Further, the biomechanical parameters of each part of the two-hole miniplate internal fixation were also analyzed. The results indicated that the two-hole miniplate model had the minimum von Mises stress value and the displacement of fracture fragment was less than 30 µm. The two-hole miniplate had an apparent compression effect on the avulsion fracture and inhibited the fracture displacement. This study would provide further guidance for clinical application in using the two-hole miniplate internal fixation.

Closed Mallet Thumb Injury-A Rare Case Report.

Introduction: Mallet thumb injuries are uncommon. Traumatic avulsion injury of the extensor pollicis longus leads to significant difficulty. Case Report: A 55-year-old male patient presented with a closed hyper flexion injury to the thumb, resulting in pain and loss of active extension. Clinical examination and x-rays confirmed a soft-tissue mallet injury. The patient was treated non-operatively by immobilizing the interphalangeal joint of the thumb. The patient regained full range of motion. Conclusion: Non-operative treatment for acute closed mallet injury of the thumb provides satisfactory outcomes. It is suitable when a patient presents acutely.

Surgical Management of Swan Neck Deformity Following Mallet Finger Injury: A Review of 25 Patients Over 20 Years.

INTRODUCTION: Swan neck deformity develops as a sequela of chronic mallet finger. Surgical management can include soft tissue reconstruction or distal interphalangeal joint (DIPJ) fusion. Studies examining the incidence and management of posttraumatic swan neck deformity following mallet fracture are limited. METHODS: A retrospective, single-institution review of patients undergoing surgical management of swan neck deformity following a traumatic mallet finger from 2000 to 2021 was performed. Patients with preexisting rheumatoid arthritis were excluded. Injury, preoperative clinical, and surgical characteristics were recorded along with postoperative outcomes and complications. RESULTS: Twenty-five patients were identified who had surgical intervention for swan neck deformity. Sixty-four percent of mallet fingers were chronic. Median time to development of mallet finger was 2 months. Twelve (48%) mallet fingers were Doyle class I, 6 (24%) were class III, and 7 (28%) were class IVB. Forty percent of injuries failed nonoperative splinting trials. Sixteen (64%) underwent primary DIPJ arthrodesis, 8 (32%) underwent DIPJ pinning, and 1 underwent open reduction and internal fixation of mallet fracture. The complication rate was 50% overall, and 33% of surgeries experienced major complications. The overall reoperation rate was 33%. Proximal interphalangeal joint hyperextension improved by 11° on average. Median follow-up was 61.2 months. CONCLUSIONS: The development of symptomatic swan neck deformity following traumatic mallet finger injury is rare. All patients warrant an attempt at nonsurgical management. Attempts at surgical correction had a high rate of complications, and DIPJ fusion appeared to provide the most reliable solution.

Multiple Bony Mallet Finger Injuries in One Hand of a 14-Year-Old Boy.

Bony mallet finger injuries, commonly seen as isolated incidents, typically occur in active individuals. We report a rare case of simultaneous avulsion fractures at the distal phalangeal bases of the second, third, and fourth fingers on the right hand of a 14-year-old boy following a forced passive flexion injury during a football game. The patient initially received conservative management with a finger extension splint for the distal interphalangeal (DIP) joints. However, one week after the injury, we performed surgical fixation on all affected digits using the K-wire extension block method due to multiple fractures and the patient's intolerance for the mallet finger splint. After six weeks, all K-wires were removed, and physiotherapy sessions began. Three months post-injury, the second and fourth DIP joints demonstrated an "Excellent" outcome, and the third DIP joint demonstrated a "Good" outcome based on Crawford's criteria for outcome assessment of mallet finger injury after management. This case highlights the importance of early detection and appropriate management of concomitant mallet finger injuries in pediatric patients to prevent potential complications that could impair hand function and quality of life.

Outcome Differences between Conservatively Treated Acute Bony and Tendinous Mallet Fingers.

INTRODUCTION: Tendinous and bony mallets are very different injuries that present with extensor lag at the distal interphalangeal joint. This study aimed to evaluate the differences in outcomes between acute bony and tendinous mallet fingers treated conservatively with splints. MATERIALS AND METHODS: We retrospectively collected data on patients with acute tendinous or bony mallets who received conservative treatment in our occupational therapy clinic. The patients were examined at an outpatient clinic, where data on pain, extension lag, and loss of flexion were recorded. Outcomes were classified according to the criteria described by Crawford. RESULTS: Data were collected from 133 patients (43 with bony and 90 with tendinous mallets). We found that bony mallet patients were predominantly younger (mean, 36 vs. 46 years), and more likely to be female (60% vs. 34%), than tendinous mallet patients. We also found that tendinous mallet injuries predominantly affected the middle and ring fingers, while bony mallet injuries predominantly affected the ring and little fingers. The initial extensor lag was worse in tendinous than in bony mallets (median, 28° vs. 15°). In addition, patients with bony mallets had significantly better outcomes with regard to the extension lag (median 0° vs. 5° p = 0.003) and the Crawford Criteria Assessment (p = 0.004), compared with those with tendinous mallets. DISCUSSION: Mallet injuries, both tendinous and bony, are common. They are often studied together and typically treated in the same manner using extension splints. However, evidence clearly shows that these are different injuries which present in the same manner. This study reinforces these findings and suggests that the outcome of conservative treatment is better for bony than for tendinous mallet fingers.

The use of Stack splint or aluminum finger splint in the conservative management of acute Doyle type IVb bony mallet finger.

BACKGROUND: The aim of this study was to compare the functional outcomes and direct costs of Stack splints and aluminum finger splints when used in the conservative management of patients with acute Doyle type IVb bony mallet finger. METHODS: We retrospectively analyzed demographic and clinical characteristics, functional outcomes (using the Crawford classification, DIP flexion angles, and extension lag measurements), time to confirmation of union, and splint costs of 24 patients treated with aluminum finger splints (Group 1) and 20 patients treated with Stack splints (Group 2). RESULTS: Of 44 patients, the median age was 38 (range, 20-59) years, 14 (32%) were smokers, 23 (52%) had fourth digit injuries, 32 (70%) had injuries to the dominant hand, 30 (68%) had a mechanism of injury of a fall, and median follow-up was 15 (range, 12-18) months; none of these differed significantly between Group 1 and Group 2 (all p > 0.05). In Group 1, functional outcomes were excellent and good in 14 (58%) and 10 (42%) patients, respectively; in Group 2 functional outcomes were excellent and good in 13 (62%) and 7 (35%) patients, respectively; and there was no significant difference between the groups. Median extension lag was 3.2° (range, 3.0°-3.5°) in group 1 and 3.4° (range, 3.2°-3.8°) in group 2, indicating no significant difference between groups. Complete union was confirmed radiographically in all patients. Per-patient cost was significantly lower for aluminum finger splints (0.208 TRY [US $0.03]) than for Stack splints (25 TRY [US $3.60]). CONCLUSIONS: Good functional outcomes are possible with the use of either Stack or aluminum finger splints in patients with acute Doyle type IVb mallet finger, confirming that conservative management may be appropriate for these injuries. Direct costs of Stack splints are many times greater than those of aluminum splints, though the costs for both are relatively low. LEVEL OF EVIDENCE: Therapeutic, Level III.

Mallet Finger Autofusion in Adolescent Post-Pin Fixation Surgery - A Case Report.

Introduction: Mallet finger is a common hand injury in sports in which the terminal extensor tendon is disrupted. This case report describes the rare occurrence of joint autofusion following surgical fixation of an unstable mallet finger injury. Case Report: We present a case of a 13-year-old right-hand dominant boy who sustained a right long finger bony mallet injury while playing football. Treatment consisted of closed reduction, percutaneous pinning of the right long finger distal interphalangeal (DIP) joint. He went on to heal with residual DIP joint stiffness and only 20° of residual motion that were noted on the early follow-up. Seven years later, he presented with no motion at the right long finger DIP joint. X-rays of his right long finger showed a complete fusion of bone across the DIP joint. Conclusion: Autofusion as a complication of mallet finger surgery is an unprecedently rare finding, especially in the absence of any predisposing factors. This complication must be considered when treating mallet finger injuries through surgical intervention. Fortunately, the loss of DIP motion, complete in this case, had no long-term effect on the overall use of this patient's hand.

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures.

PURPOSE: In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. METHODS: A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. RESULTS: At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from -6° to -14°) and Michigan Hand Outcome Questionnaire score (median difference, -1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. CONCLUSIONS: Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

New technique for the treatment of fresh bony mallet finger: A retrospective case series study.

Background: The bony mallet finger is a tear fracture of the extensor tendon, resulting in a flexion deformity of the finger, which affects both the function of the finger. The classical Ishiguro's method is associated with damage to the cartilage of the distal interphalangeal (DIP) joint and always lead to the joint stiffness. This paper explores a new technique to overcome the shortcomings of the classical Ishiguro's method and achieve better clinical efficacy. Methods: We examined 15 patients with bony mallet fingers, 9 males and 6 females, from February 2020 to June 2022, ranged from 23 to 58 years, including 1 case of index finger, 5 cases of middle finger, 3 cases of ring finger and 6 cases of little finger. The median course of the injury to surgery was 2 days (range, 1∼7 days). All had fresh closed injuries, according to the Wehbe and Schneider classification: 4 cases of type IA, 6 cases of type IB, 3 cases of type IIA and 2 cases of type IIB. All patients were treated surgically by the new technique. Post-operative follow-up was conducted to record the healing of the fracture, the pain of the affected finger and the function of joint movement. Results: The 15 cases were followed up after surgery. The median active range of motion was 65° (range, 55∼75°). The median extension deficit of DIP joint was 0° (range, 0∼11°). The median clinical healing time of the fracture was 6 weeks (range, 6∼10 weeks). None of the patients experienced significant pain. The patients were assessed according to the Crawford criteria at the final follow-up: 11 cases were assessed as excellent, 3 cases were assessed as good and 1 case was assessed as fair. No loss of fracture repositioning, loosening of internal fixation, skin necrosis or infection was observed. Conclusion: The application of the new technique for the treatment of bony mallet fingers has the advantages of good stability, fracture healing and functional recovery of the DIP joint, making it an ideal surgical procedure for the treatment of fresh bony mallet fingers.

[Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger].

Objective: To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger. Methods: Between January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training. Results: The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%. Conclusion: Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.

Treatment of chronic mallet finger with swan neck deformity using a modified Spiral Oblique Retinacular Ligament (SORL) reconstruction procedure: A case series and technical note.

INTRODUCTION AND IMPORTANCE: Chronic terminal extensor tendon injury produces mallet deformity and secondary swan neck deformity. It can be found in neglect cases and in a failed cases after conservative treatment or primary surgical repair. Surgery is considered in cases with extensor lag of more than 30° and functional deficit. Reconstruction of the spiral oblique retinacular ligament (SORL) has been reported in literatures to correct swan neck deformity by a dynamic mechanical basis. CASE PRESENTATION: Three cases of chronic mallet finger associated with swan neck deformity were treated by the modified technique of SORL reconstruction. Range of motion (ROM) of distal interphalangeal (DIP) joints and proximal interphalangeal (PIP) joints were measured along with the complications. The clinical outcome was reported using the Crawford's criteria. CLINICAL DISCUSSION: All patients had an average age of 34 years (20-54). Average time to surgery was 16.67 months (2-24) and average of DIP extension lag was 66.67°. All patient gave excellent Crawford criteria at the latest follow up (average 15.3 months). The average PIP joint ROM were -1.60 (00 to -50) of extension and 1100 (1000-1200) of flexion for the PIP joint and -1.60 (00 to -50) of extension and 83.330 (800-850) of flexion for the DIP joint. CONCLUSION: We present our technique to manage chronic mallet injury which only utilized two skin incisions and one button at the distal phalanx to minimize risk of skin necrosis and patient discomfort. This procedure can be considered as one of the options for the treatment of chronic mallet finger deformity associated with swan neck deformity.