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 always transient. For the 45 surgically treated digits the complication rate was 53%, with 76% of these complications still present at a mean follow-up of 38 months. Six digits treated initially with splinting (minimum of 6 weeks) and later with surgery were included in both groups. Major complications in the patients undergoing surgery included deep infection (4%), joint incongruity (18%), and nail deformity (18%). In addition, seven patients (16%) required reoperation, and all of these had an unsatisfactory result except that in one finger the outcome was unknown.