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Mallet finger treatment

Conservative treatment of mallet finger: A systematic revie

In all 4 RCTs mallet fingers were immobilized continuously for 6 weeks in acute injuries and 8 weeks for chronic injuries. Conclusions: Two of the three studies found a large effect size for orthotic intervention ranging from 2.17 to 12.12. Increased edema and age and decreased patient adherence seem to negatively influence DIP extension gains What's included in Mallet Finger On Demand: A Simple Self Treatment Program. You will get unlimited, 24/7 access to this self paced, online video program, to complete at a time most convenient for you. In addition, get immediate access to 2 FREE videos to learn more about your mallet finger injury Patients may not present to the orthopedist with mallet finger for weeks or even months, perhaps having received no treatment or ineffective treatment. Bony injuries heal within weeks; thus, an old..

Treatment for mallet finger : Mallet Finge

To do this: Hold your hand to support the middle joint on either side. Bend that joint, keeping the splinted part of your finger straight. Do this 10 times, 4 to 5 times a day Mallet Finger Self-Care at Home If the finger is cut, clean the cut under running water for a few minutes. Then wrap the finger with clean gauze or a clean cloth. Apply a moderate amount of.. Treatment for Mallet Finger Mallet Finger Symptoms. A mallet finger is an obvious injury, if you know what you're looking for: the last joint of the... Causes. A mallet finger is an injury to the extensor tendon on the back of the finger, which is the tendon used to... Diagnosis. Diagnosing mallet. Most mallet finger injuries are treated with splinting. A splint holds the fingertip straight (in extension) until it heals. There are several types of splints used to treat mallet finger, many of them fabricated by hand therapists. Reproduced from Culver JE Jr: Office management of athletic injuries of the hand and wrist

Mallet Finger Treatment & Management: Approach

  1. Treatment of Mallet Finger Dr Mathew RicksBSC MBBS MSC Trauma MSC FRCs TR & OrthoConsultant Upper Limb Orthopaedics Surgeon Washington Hospital, UKOrthoTV :.
  2. g injuries in ball sports are common. The anatomy of the dorsal apparatus of the fingers is complex and has generated detailed descriptions
  3. Medical treatment for mallet finger. The orthopedists here at Maryland Orthopedic Specialists usually splint a mallet finger to restore its normal position. The splint holds the joint straight, and you wear it 24 hours a day for six weeks, but some patients may need to wear it for longer. This treatment usually restores full function and.
  4. Splinting is the mainstay of treatment for most mallet fingers and mallet fractures. A small splint is applied just to the end joint of the finger, allowing the other two joints to move
  5. Mallet Finger On Demand is a convenient, accessible, and secure program created by Michelle Coil, Board Certified Hand Therapist and the founder of Virtual Hand Care, LLC. Virtual Hand Care, LLC is a digital healthcare company with a focus on creating recovery solutions for people specifically with hand, wrist, elbow, and shoulder injuries
  6. What Are the Treatment Options for Mallet Finger? The general protocol for conservative treatment of a mallet finger is to splint the tip of the finger straight for approximately 6 to 8 weeks and then start to move it as long as it is stiff and does not droop
  7. Mallet Thumb • Unlike mallet finger, avulsion of the extensor pollicis longus (EPL) tendon at its distal insertion (mallet thumb) is rare. • Although the recommended treatment for closed mallet finger is conservative, some authors proposed operative treatment for mallet thumb. 78

Most of the time mallet fingers can be treated without any surgery but most of the time people with acute or chronic mallet disease are recommended to have surgery due to failed treatment. Terminal extensor tendon injuries are very common in mallet finger injuries and almost 5.6 percent of the injuries are of the wrist as well as hand Patients and methods: In 101 patients a tendinous mallet finger was present, and in 20 patients a bony mallet finger. After immobilising the distal interphalangeal (DIP) joint at 0° extension with a Kirschner wire, the extensor tendon was repaired by using a dorsal deepithelialised skin flap reinserted transosseous Mallet finger usually results from forced flexion of an extended finger. Treatment can be difficult as patient compliance is essential, and if not treated appropriately the injury can lead to permanent deformity. Patients will present with a flexion deformity of, and inability to actively extend, the distal interphalangeal joint mallet fracture). What are the Symptoms? • Pain and swelling over the end of the finger • The end of the finger lies in the bent position at rest • The inability to hold the finger straight at the end joint An X-ray should be taken to look for a fracture. What is the Treatment? Splintage Phase A splint will be applied to keep the finger in

Mallet Finger: Symptoms & Treatment The Hand Societ

  1. We recommend extension splinting to treat patients who present with closed mallet fingers early or late if they fulfill the selection criteria outlined. The success rate is equivalent or better than results previously reported for patients treated surgically, and complications associated with operative procedures are avoided
  2. e which mallet fractures need surgery. Mild sedation is ad
  3. The major symptom of mallet finger is an inability to actively extend the fingertip as well as pain and swelling. Mallet finger may be treated with or without surgery. Non-surgical treatment consists of placing a splint with the fingertip extended. Flexion of the fingertip at any point during the treatment period will delay healing
  4. al extensor band in zone 1, and is characterized by intact skin and division of the tendon insertion alone (tendinous mallet) or an avulsion of less than one-third of the articular surface of the distal phalanx (bony mallet) [Rx,Rx].The expression mallet finger is inaccurate because the deformity is reducible in its acute phase []

Mallet fracture with volar subluxation of the distal phalanx. Stable mallet fracture that involves 40% of the joint surface. Dorsal aluminum foam splint for the treatment of a mallet finger. Stack splints are widely used for the treatment of mallet finger. Molded plastic stack splint for the treatment of mallet finger Mallet finger treatment. The mallet finger deformity is easy to diagnose because the patient is unable to extend the distal phalanx of a finger. A lateral radiograph of the finger usually shows whether this is a fracture-type mallet or a purely tendinous disruption. These injuries are commonly the result of a work-or sports-related injury Mallet Finger Rehabilitation Protocol Conservative Management Kelly Holtkamp, M.D. There are two types of Mallet Finger deformity. The first type is called a bony mallet deformity which involves a fracture of the bone. The extensor tendon is attached to this bone. The secon Instructions for Mallet Finger Treatment Purpose: This document is to help you understand your injury, and reinforce the treatment required to get the best results possible. Diagnosis: A mallet finger refers to an injury whereby the extensor tendon to the tip joint (distal interphalangeal) of the finger is disrupted or torn

of mallet finger of treatment This study reviews complications of treatment in 123 mallet fingers treated operatively and nonoperatively. In the 84 digits splinted there was a 45% rate of complications, mostly skin related; however, these complications were almost ahvays transient. For the 45 surgically treate Treatment. Treatment depends on the severity of the injury. An X-ray or MRI may be used to determine if the tendon is torn if there is an avulsion or a fracture to the end bone of the finger.; If there is no avulsion or fracture, then a mallet finger splint may be worn for up to eight weeks A mallet finger s treated by bringing the tendon ends back together to allow those two ends of the tendons to heal. The ends must be in contact for approximately 12 weeks. A splint is used to hold the finger joint straight and bring the tendon ends together Fortunately most patients with mallet finger injuries can be treated successfully without surgery, even if there is a fracture. If the joint is in good alignment with the splint, surgery is not necessary. Non-operative treatment requires full-time use of a finger splint for at least 6-8 weeks. Light use of the hand and gentle range of motion of.

How to treat mallet finger Most mallet finger or baseball finger injuries are treated non-surgically. Immobilization with a small splint is important to avoid further injury or discomfort. Your hand surgeon can help create a splint to keep the fingertip straight and protected while it heals. Icing the injury quickly will help with pain and. Mallet Fingers should be treated as quickly as possible with a splint that immobilizes the DIP joint for 4 to 6 weeks. Delayed treatment may still be effective with good adherence to a long term splinting program. Untreated Mallet Finger my ultimately result in the development of PIP joint hyperextension or Swan Neck deformity. Finger Splinting. Mallet Finger is a finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint. Diagnosis is made clinically with a presence of a distal phalanx that rests at ~45° of flexion with lack of active DIP extension. Treatment is usually extension splinting of DIP joint for 6-8 weeks. Surgical management is indicated for. Treatment Options. Nonoperative management has been suggested as first-line treatment option for almost all mallet finger injuries. 35 It is currently considered the standard of care for all injuries with no associated fracture, no volar subluxation of the distal phalanx, or cases with involvement of less than one-third of the articular surface. 3,4,29 Treatment involves complete. Mallet finger injuries are common tendon injuries in the finger. The extensor tendon of the distal interphalangeal (DIP) joint may sustain damage of varying degrees, from partial tear to complete rupture, as characterized by Doyle's classification system 1 (Table 1, Fig. 1).The goal of management is to restore active DIP joint extension and prevent a swan neck deformity (DIP joint extensor.

Mallet Finger Recovery and Treatment in Houston, TX The hands are made of a complex system of bones, muscles, tendons, and more. These tiny components are responsible for many important functions and movements that we utilize in our everyday lives, making an injury to this area rather difficult to manage without proper care from a professional Mallet finger most often occurs when something hits the tip of your straightened finger and bends it down with force. What to Expect. Wearing a splint on your finger to keep it straight is the most common treatment for mallet finger. You may need to wear a splint for different lengths of time. If your tendon is only stretched, not torn, it. Mallet finger injury no splint treatment by hand exercises. This video illustrates mallet finger non-splint treatment with an exercise technique developed by Valdas Macionis, MD, PhD. The technique is based on frequent hold-relax tip-to-tip power pinch exercises. Splint and surgery related problems can be avoided

Mallet Finger Treatment. The majority of mallet finger injuries can be treated without surgery. Ice should be applied immediately, and the hand should be elevated with the fingers toward the ceiling. Medical attention should be sought within a week after injury, or the finger could heal improperly, leading to more permanent damage The majority of mallet finger injuries can be treated conservatively. If the x-ray shows the tendon has just pulled away without a bony fragment, a non operative treatment in a splint will lead to satisfactory results in most patients Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb. Although it is also known as baseball finger, this injury can happen to anyone when an unyielding object (like a ball) strikes the tip of a finger or thumb and forces it to bend further than it is intended to go Although splinting is the treatment of choice for most type I mallet finger injuries, surgery may be advantageous for individuals who are unable to comply with a splinting regimen or for patients who would have difficulty performing their jobs with an external splint (eg, surgeons, dentists, musicians). 1,20 To immobilize the DIP joint in.

The mallet finger is a stable injury. If the patient presents with lack of active extension of the DIP joint, then splinting of the finger in extension or slight hyperextension for 8 weeks is the treatment of choice. It is important to educate these patients not to remove the splint Treatment of Mallet Finger. Mallet finger can often be treated without the need for surgery. In these cases, a splint will be used to straighten the finger out and allow the extensor tendon to heal. This splint will need to be worn at all times for up to eight weeks. Once this initial period is over, patients will typically need to wear the. Mallet finger is a condition in which the tendon in the outermost joint of a finger is ripped, causing the tip of the finger to droop. Also known as baseball finger, it is an injury that is typically sustained while playing sports finger injury. It describes the injury, symptoms and treatment. What is a mallet finger? A mallet finger is where the end joint of the finger bends towards the palm and cannot be straightened. This is usually caused by an injury to the end of the finger which has torn the tendon that straightens the finger Systematic review of the studies on conservatively treated mallet finger injuries is not able to identify which orthosis is most optimal and what the most appropriate wear time is, and therefore recommends that the orthotic material choice should be based on the treatment provider's comfort . and the patient's lifestyle and concerns

The time you wear your splint, and your rehabilitation recovery is greatly affected by your type of mallet finger injury. A Mallet Finger Injury can be the most annoying little injury! It can take a long time heal, and can be very complicated to treat. Mallet finger injuries are a pain because you have to wear a splint 24/7 and often times. Surgery for Mallet Finger It is not common to treat a mallet finger surgically, unless bone fragments or fractures are present. If that is the case, surgery is done to repair the fracture using pins to hold the pieces of bone together while the injury heals. Surgical treatment of the damaged tendon usually requires a tendon graft, where tendon. The treatment of soft-tissue mallet fingers in children can be challenging because of delays in diagnosis and noncompliance with extension splinting or casting. The purpose of this investigation.

Mallet finger - NHS - NH

Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment. This paper will review the current treatment guidelines for the surgical and non-surgical management of mallet finger Mallet Finger associated with large fractures or joint damage may require surgical intervention. The surgeon will use tiny pins, wires or screws to repair any fracture (s) allowing the bone to grow back together. In severe cases the joint may be fused straight. The tendon may be repaired with sutures or grafts depending on the extent of damage

Mallet Finger Non-Surgical Treatment. Apply ice to the injured finger joint to reduce swelling and tenderness. You can take an over-the-counter painkiller, such as ibuprofen, or paracetamol to help relieve the pain. Extension splinting also known as mallet finger splint of DIP joint for 6-8 weeks. Maintain free movement of the PIP joint Mallet Finger On Demand: A Simple Self Treatment Program. THE ONLY STEP BY STEP MALLET FINGER PROGRAM ON THE INTERNET. If you have found this article helpful, do us a favor and share on our social media channels If this conservative treatment does not give her the results she wants, there are surgical options. Splinting is currently considered the best option. Reference: Nina Suh, MD, Scott W. Wolfe, MD. Soft Tissue Mallet Finger Injuries With Delayed Treatment. In Journal of Hand Surgery . September, 2013. Vol 38A. Pp. 1803-1805 Traumatic disruption of the terminal slip of the extensor tendon at the distal interphalangeal (DIP) joint is commonly referred to as a mallet finger (or, less often, as a baseball or drop finger) ( figure 1 ). The terminal slip is formed by the convergence of the extensor lateral bands and inserts on the distal phalanx

A mallet finger is an injury to the end joint of your finger. You either have a bone or tendon injury. This causes the fingertip to droop. This is a common injury The symptoms following this type of injury often include: Pain straight after an injury Swelling Inability to straighten the end joint of your finger without help What happens now Treatment. Mallet finger can be treated non-surgically by applying a specially designed splint for 6-8 weeks. Immobilizing the finger with a splint helps promote natural healing of the torn tendon or bones. For patients who require use of their fingers to perform occupational tasks, internal splints can be used; this involves surgical placement. Treatment of the soft tissue Mallet finger centers on placing the injured finger in an extended position to better approximate the ruptured tendon edges. In most cases, the tendon will heal and the DIP joint motion will be functional. Normal physiology of healing will allow the two ends to reapproximate Although mallet finger seems like a small and sometimes insignificant injury the healing process can feel long. The good news is that the vast majority of mallet fingers will heal without surgery. Initial treatment is a strict splinting regimen for 6-8 weeks. This involves a splint that keeps the most distal finger joint in complete extension In children, mallet finger injuries may involve the cartilage that controls bone growth. The doctor must carefully evaluate and treat this injury in children so that the finger does not become stunted or deformed. Surgical Treatment. Surgical repair may be considered when mallet finger injuries have large bone fragments or joint mal-alignment

Mallet Finger Rehabilitation Protocol Surgical Management Kelly Holtkamp, M.D. There are two types of Mallet Finger deformity. The first type is called a bony mallet deformity which involves a fracture of the bone. The extensor tendon is attached to this bone. The secon Mallet finger is a common athletic injury that affects basketball and baseball players' routinely jammed fingers, but the injury can occur because of a crushing accident on the job, or even because of a cut finger while working in the kitchen. Any rapid motion that jams the tip of a finger against an object can cause a mallet finger Mallet finger is defined as a stretching or tearing of the extensor tendon or a complete avulsion of the tendon insertion from the dorsal base of the distal phalanx with or without bony avulsion. The injury results in the inability to completely extend the distal interphalangeal (DIP) joint. It is most commonly caused by sudden forced flexion.

10 Symptoms and Treatments of Mallet Finger. allet Finger is an injury that typically occurs in sporting activity when a ball hits the fingertip or thumb so strongly that the tendon is severely damaged. In the USA this injury may also be called a baseball finger since this is one of the contexts where it most frequently happens Operative treatment of mallet finger fractures is generally recommended for patients in whom more than one-third of the articular surface is involved with volar subluxation. We present a case of conservative treatment with chronic nonunion of a mallet finger fracture after failed mallet finger surgery.Presentation of Case: A 16-year-old boy presented with a bony fragment (mallet formation) of.

Mallet Finger Treatment Melbourne The hand therapists at Action Rehab are experienced in the assessment and treatment of mallet finger injuries. With a strong reputation in managing sports injuries, Action Rehab is the smart choice for treating your mallet finger Treatment of Mallet Finger - Dr Mathew Ricks . Categories. Spine . Arthroplasty . Trauma . Surgical Videos . Foot and Ankle . Post Graduate Education . MOA Webinars . OrthoTV Original . Hand & Microsurgery . POSI Webinars . Search Videos. Top Channels. Arthroplasty Channel 28 videos. 9784 views. Paediatric Orthopaedic Video Mallet Finger Treatment. The majority of mallet finger injuries are treated conservatively with physiotherapy. Ice packs can be useful to relieve pain in the early stages. The terminal interphalangeal joint (the joint in the finger closest to its tip). Mallet finger or baseball finger can be frustrating and painful, but Atlanta Hand Specialist offers multiple treatment options to remedy this condition. The physicians and staff at Atlanta Hand Specialist provide innovation solutions for a wide range of conditions affecting your hands, arms, fingers, and thumb How are mallet fingers treated? Most patients with mallet fingers can be treated successfully with a splint, even if there is a fracture. If the joint is in good alignment within the splint, surgery is not necessary. Non-operative treatment requires full-time use of a finger splint for at least 6-8 weeks

Mallet finger: Treatment of this difficult finger injury

The mallet finger splint The mallet finger splint is a simple splint and effective way to treat this injury. The splint is designed to keep the joint straight while the tendon heals. When the joint is straight there is only a small gap between the ends of the tendon (or bone). Scar tissue froms in the gap and makes a snug repair. Without the. Treatment. Mallet finger can be treated non-surgically by applying a specially designed splint for 6-8 weeks. Immobilizing the finger with a splint helps promote natural healing of the torn tendon or bones. For patients who require the use of their fingers to perform occupational tasks, internal splints can be used; this involves surgical.

Mallet finger Treatment. Courtesy: Prof Nabil Ebraheim, University of TOledo, Ohio, USA. Post Views: 930. Related Posts. This renowned classic provides unparalleled coverage of manual muscle testing, plus evaluation and treatment of faulty and painful postural conditions. The thoroughly updated Fifth Edition is completely reorganized and. What is the treatment for mallet finger? More commonly only the tendon is injured or the fracture fragment is very small. An operation to repair the injury is then not possible. Instead the joint must be held straight in a splint for about 6 weeks to help the tendon to heal. The splint keeps the injured joint straight but allow Mallet finger - Treatment. Treatment for mallet finger includes: Ice. For the first one to two days, ice should be applied for 15 minutes every three to four hours to reduce swelling and tenderness. Do not apply the ice directly to the skin. Pain Medication Treatment for Mallet Finger. Generally, mallet finger can be treated non-surgically using specially designed splints that immobilize the finger and promote natural healing. In cases of fracture, complete bone healing may take 6-8 weeks, followed by physical therapy for strengthening. In severe cases that don't respond to conservative. But in tendon injury, there is a difficulty in moving joints of the body. So in this article we are going to discuss one of the tendon diseases that is Mallet finger and its Ayurvedic treatment. Introduction. Mallet finger is the injury to the small tendon of the finger and thumb which is helpful in the extension of the finger

Untreated Mallet Finger. If left untreated, mallet finger can develop into a finger joint deformity referred to as a swan neck deformity. Treatment for Mallet Finger. Generally, mallet finger can be treated non-surgically using specially designed splints that immobilize the finger and promote natural healing. In cases of fracture, complete bone. Mallet fingers rarely require surgery. The most common treatment is to place the finger in a splint for approximately six weeks. The splint will secure the finger in a straight position. The splint will also allow the torn tendon to properly heal back into the proper position. Upon removing the splint, the patient's injured joint is usually. Mallet Finger Treatment. Your doctor will likely first try a nonsurgical approach to treat your mallet finger, unless you have an open injury (broken skin) or a complex injury. Nonsurgical treatment includes splinting, pain control, injury protection, and finger exercises: Mallet finger splint: A splint holds the finger in the extended position Mallet Finger: Symptoms, Causes And Treatment . By Amritha K. on May 9, 2019 A mallet finger is commonly considered to be an athletic injury and is also termed as hammer finger. It occurs when the outermost joint of the finger gets injured. The injury makes it impossible to extend or move the fingertips without applying some kind of force

The Mallet finger deformity causes a droop of the fingertip. This is caused by an injury to the extensor tendon at the last finger joint. The treatment requires patience and strict adherence to the splinting instructions in order to allow the tendon to heal. Treatment Treatment for a Typical Mallet Finger. Typical treatment with an alumifoam splint for mallet finger injuries. 8 weeks full time splinting, 4 weeks part time splinting. Full time splinting of the DIP JOINT distal interphalangeal joint (8 weeks). During this time the splint is usually applied to the dorsal side or nail side of the finger Keywords: Mallet fracture, mallet finger, extension block, distal interphalangeal joint fracture, surgical treatment 1. Introduction Missed injuries have been referred to as the trauma surgeon's nemesis [1, 2]. Missed injuries is Mallet finger deformity is usually a result of a sports injury which results in an axial loading o Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb.As a result, you are not able to straighten the tip of your finger or thumb on your own. With a mallet finger injury, the fingertip droops and cannot be actively straightened

Mallet Finger Injuries | eOrthopod

Mallet finger treatment. If you have injured your finger and it is painful, swollen, or difficult to straighten, see your doctor right away. Delaying treatment can cause permanent damage or may make your injury more difficult to fix. In most cases, your doctor may tell you to put ice on the injury to prevent swelling Treatments for mallet finger. Although early intervention and treatment for mallet finger is crucial, most cases of mallet finger can be treated without surgery. If you suspect you have mallet finger, ice and elevate the hand immediately and visit your orthopedic physician within a week. First-line therapy for mallet finger is splinting or. A mallet finger is a very painful, and often very debilitating, injury that involves the tip of the finger. The injury occurs when an object, such as a ball, hits the player on the tip of the finger. It involves the extensor tendon, which is the tendon that extends the tip of the finger, being pulled off of the distal phalanx, or the bone at. Treatment options for mallet finger vary depending on the length of time after injury that the droopy finger shows up (its not always immediate). Treatment is deemed successful if there is little or no extensor tendon lag, meaning you are able to straighten your finger fully. The most conservative treatment option is long term splinting

Oval-8 Finger Splint Size 9

Mallet Finger - Diagnosis and Treatment. Physical examination and X-ray of the injured finger help in establishing diagnosis of mallet finger.Wearing finger splints is the most common treatment. Mallet Finger Injury Treatment - Bartlett, IL. A mallet finger injury is a deformity of the finger that occurs when the extensor tendon - responsible for straightening your finger - becomes damaged. This damage can occur if your finger is forcibly bent or if the extensor tendon is torn. Symptoms of a mallet finger injury include pain, swelling. With a Mallet Finger, the fingertip cannot straighten on its own: it droops. The finger may be painful, swollen and bruised, especially if the bone has torn from the tendon (avulsion). Occasionally, blood collects beneath the nail, causing the nail to become detached at the base of the nail. TREATMENTS In most cases, you can treat Mallet Finger. Best treatment for mallet finger. Source: BestBETS (Add filter) 06 May 2010 BestBets: Best treatment for mallet finger. Type: Evidence Summaries . Add this result to my export selection Interventions for treating mallet finger injuries. The aim of this study was to describe and assess a surgical technique for the treatment of mallet finger fractures using a pull-out wire with K-wire stabilization of the distal interphalangeal (DIP) joint in extension. (Level IV evidence) Jersey Finger; Evans RB: A study of the zone 1 flexor tendon injury and implications for the treatment

Mallet Finger Treatment - YouTub

Treatment of mallet finger due to intra-articular fracture of the distal phalanx. J Hand Surg [Am]. 1978;3:361-3. 7. Suprock MD, Hood JM, Lubahn JD. Role of antibiotics in open fractures of the. A Mallet Finger treatment outcome assessment classification was proposed by Crawford. It is the most commonly used classification for outcome assessment after mallet finger. Makhlouf and Deek have considered surgery when splinting cannot correct acute deformities; however, we will review the present literature for acute open and chronic.

Mallet Finger: Causes, Symptoms, and Treatmen

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Mallet Finger Treatment - Physiotherapy Treatmen

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Extension Block Pinning Versus Hook Plate Fixation for

Occupational Therapy for Mallet Finger Treatment

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