For fresh mallet finger with terminal tendon rupture, conservative treatment is the method chosen by many hand surgeons. However, long-term splinting is troublesome and also tends to cause an extension deficit or impaired flexion of the distal interphalangeal joint. In this article, the surgical treatment of fresh mallet finger is discussed as an alternative to conservative splinting. Fifteen patients underwent surgical intervention with a wire implant combined with mobilization in the early postoperative period. By 1 year after surgery, the mean extension deficit was reduced to 6 degrees, and an improvement of 34 degrees was observed. The active range of motion of the distal interphalangeal joint reached 58 degrees, which was 65.8 percent of that on the unaffected side. These surgically treated patients expressed greater satisfaction with the outcome than did a conservatively treated group. We concluded that for patients to whom fine manual dexterity is important, surgery is a better option than conservative therapy in treating fresh mallet finger.