Abstract
BackgroundMallet finger injuries are usually successfully treated non-operatively with a splint. Most patients are reviewed at least twice in a clinic after the initial presentation in A&E. A new protocol promoting “self-care” was introduced at our institution. Patients were provided with structured verbal and written information, and given access to a telephone helpline.MethodsA prospective electronic patient record was used to identify all patients who presented to the emergency department with a mallet finger with a minimum six month follow-up. A satisfaction and patient reported outcome measure was administered via a postal questionnaire. The response rate was 36/47 (77%).ResultsThe median QuickDASH score was 2.3 (IQR 0 to 4.6). All patients were satisfied with the treatment plan provided. Nine used the helpline and all were satisfied with information given. Although 13 patients reported some extensor lag, or bump, they had no functional limitation. Seven patients were reviewed by the general practitioner or other clinicians during their treatment period for issues such a skin care, splint size changes or sickness certification. Five were subsequently reviewed at the end of their treatment period in a clinic at their request, or their general practitioner, but did not require further surgical intervention.ConclusionsSelf-care for mallet finger injuries, with adequate patient information and telephone back-up, leads to acceptable functional results and satisfaction.Level of evidence: III
Highlights
The “mallet finger” injury is usually caused by forced hyperflexion of the distal interphalangeal joint (DIPJ), disrupting the terminal extensor tendon, or causing a fracture at the tendon insertion [1]
The second patient had their injury advice on suitable exercises to be done once the splint was removed and one patient (3%) would have liked a follow up appointment for reassurance
A Cochrane review examined the interventions for treatment of mallet finger, at four randomised controlled trials (RCT), involving a total of 278 participants with 283 mallet finger injuries and concluded that no difference could be detected between different splint types [11]
Summary
The “mallet finger” injury is usually caused by forced hyperflexion of the distal interphalangeal joint (DIPJ), disrupting the terminal extensor tendon, or causing a fracture at the tendon insertion [1]. The majority of injuries occur to the dominant hand, in the ulnar sided digits [2].The aim of treatment is to achieve tendon healing without elongation, and long-term extensor lag. A very small minority of injuries that combine a fracture with DIPJ subluxation may benefit from early identification and operative management. A long term follow-up found excellent functional outcome that was independent of extensor lag, bony involvement or the development of radiological DIPJ osteoarthritis [5]. Most patients are reviewed at least twice in a clinic after the initial presentation in A&E. Patients were provided with structured verbal and written information, and given access to a telephone helpline
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