Mallet Finger Research Articles

Reconstruction of Chronic Soft Tissue Mallet Fingers: Outcomes of Step-Plasty vs. Purse-String Suture.

After failed conservative therapy or in the absence of any intervention, a rupture of the digital subcutaneous extensor tendon at the distal interphalangeal (DIP) joint, known as mallet finger, may lead to a chronic extension deficit due to excessive scarring and tendon elongation. Various surgical techniques to restore the extension of the distal phalanx have been proposed, but an optimal approach has not yet been established. To tighten the extensor tendon, a purse-string suture can be applied. Although it has shown efficacy, it can result in significant bulging and scar formation. Using the "abbreviato" technique, the elongated part of the extensor tendon is excised, and the tendon is re-sutured. Also, tenodesis has been described, particularly in pediatric cases. In this retrospective follow-up study, we aimed to investigate if the step-plasty procedure previously described by Baumeister provides comparable, if not superior, functional and aesthetic outcomes compared to existing techniques for patients with chronic mallet finger. In this retrospective study, a consecutive series of 68 patients with chronic mallet fingers was enrolled. Patients were treated surgically using step-plasty of the respective extensor tendon. After skin incision and tenolysis, the elongated extensor tendon was incised in a Z-like fashion and stepwise resected in the transverse portion of the Z. The functional and aesthetic effects of this step-plasty technique were compared with results of 44 patients previously treated using purse-string sutures of the extensor tendon and evaluated using Crawford's and Levante's criteria. In all patients undergoing the step-plasty procedure, the extension deficit was significantly reduced from an average of 42 degrees preoperatively to 11 degrees postoperatively. In contrast, the control group treated by purse-string sutures showed a slightly higher postoperative extension deficit of 15 degrees. According to Levante's criteria, the results of our step-plasty procedure were significantly better than those achieved with purse-string sutures. Our study demonstrated that the treatment of older or chronic subcutaneous extensor tendon ruptures using the step-plasty technique led to a significant reduction in extension deficits. According to Levante's criteria, the postoperative outcome was significantly better in comparison to the purse-string suture technique. Additionally, no skin resection was required to improve the extension capability of the distal finger joint, compared to established surgical procedures.

Effectiveness comparison of open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation for bony mallet finger

To compare the effectiveness of open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation for bony mallet fingers. The clinical data of 68 patients with bony mallet finger who admitted between May 2019 and June 2022 were retrospectively analyzed. Among them, 33 cases were in the open group (treated with open reduction and hook plate fixation) and 35 cases were in the closed group (treated with closed indirect reduction and dorsal extension blocking Kirschner wire fixation). There was no significant difference between the two groups in terms of gender, age, the affected side, the affected finger, cause of injury, time from injury to operation, and Wehbé-Schneider classification ( P>0.05). The operation time, intraoperative fluoroscopy frequency, fracture healing time, time of returning to work, and postoperative complications were recorded and compared between the two groups. At 12 months after operation, visual analogue scale (VAS) score was used to assess the pain of the injured finger, active flexion range of motion and extension deficit of the distal interphalangeal joint (DIP) were measured by goniometer, and the effectiveness was assessed by Crawford criteria. All patients in the two groups were followed up 12-26 months, with an average of 15 months. There was no significant difference in the follow-up time between the closed group and the open group ( P>0.05). The operation time in the closed group was shorter than that in the open group, and the intraoperative fluoroscopy times, the fracture healing time, and the time of returning to work in the closed group were more than those in the open group, and the differences were significant ( P<0.05). In the closed group, there were 5 cases of pinning tract infection and 3 cases of small area pressure ulcer skin necrosis on the dorsal side of the finger, which were cured after intensive nursing and dressing change. Local nail depression deformity occurred in 7 cases in the open group, and the deformity disappeared after removal of plate. The incisions of the other patients healed uneventfully without complications such as infection, skin necrosis, exposure of the internal fixation, or nail deformity. There was no significant difference in the incidence of skin necrosis between the two groups ( P>0.05), but the differences in the incidence of infection and nail deformity between the two groups were significant ( P<0.05). There was no significant difference in VAS score, DIP active flexion range of motion, DIP extension deficiency, or Crawford criteria evaluation between the two groups at 12 months after operation ( P>0.05). At last follow-up, there was no DIP osteoarthritis and joint degeneration in both groups. Open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation have their own advantages and disadvantages, but both of them have good results in the treatment of bony mallet fingers. Open reduction and hook plate fixation is recommended for young patients with bony mallet fingers who are eager to return to work.

Patient-specific 3D-printed Splint for Mallet Finger Injury.

Despite the frequency of mallet finger injuries, treatment options can often be costly, time-consuming, and ill-fitted. Three-dimensional (3D) printing allows for the production of highly customized and inexpensive splints, which suggests potential efficacy in the prescription of casts for musculoskeletal injuries. This study explores how the use of engineering concepts such as 3D printing and topology optimization (TO) can improve outcomes for patients. 3D printing enables the direct fabrication of the patient-specific complex shapes while utilizing finite element analysis and TO in the design of the splint allowed for the most efficient distribution of material to achieve mechanical requirements while reducing the amount of material used. The reduction in used material leads to significant improvements in weight reduction and heat dissipation, which would improve breathability and less sweating for the patient, greatly increasing comfort for the duration of their recovery.

Reverse Ishiguro Extension Block Technique as an Alternative for Irreducible Osseous Mallet Finger.

Subacute or late-presenting unstable osseous mallet finger might be hard to reduce and, therefore, remain subluxed when using the traditional Ishiguro technique. In such cases, we suggest it is best to prioritize correction of joint subluxation over step-by-step adherence to the traditional Ishiguro technique. Specifically, we contend that carrying out the procedure in reverse order typically results in an easier and more stable reduction of both joint and fracture.

Alternative Technique Using Opencast for Early Return to Play after Operation in Patients with Bony Mallet Finger by Sports Injury: A Retrospective Study in a Tertiary Hospital in South Korea

Alternative Technique Using Opencast for Early Return to Play after Operation in Patients with Bony Mallet Finger by Sports Injury: A Retrospective Study in a Tertiary Hospital in South Korea

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.

Incidence of hand and wrist disorders in primary care.

The incidence of different types of hand and wrist disorders in primary care is unknown since there are no specific encodings for it. To determine the overall incidence and the incidence of specific types of hand and wrist disorders in primary care. A healthcare registration database from Dutch general practice, which contains medical records of over 200 000 patients and included approximately 25% of the population of the area of Rotterdam. Patients aged ≥18 years with a new diagnosis of hand or wrist disorder from 1 January 2015 to 31 December 2019 were extracted using a search algorithm based on ICPC coding and search terms in free text. The mean incidence over the study period of a hand disorder was 5.9 per 1,000 persons-years and of a wrist disorder 0.3 per 1,000 persons-years. The incidence of trigger finger/thumb, fracture hand/finger, tendon/ligament tendinopathy, mallet finger and ligament injury hand/finger were 3 (2.69-3.15), 1 (1.03-1.33), 1 (0.98-1.28), 0.6 (0.48-0.69) and 0.1 (0.06-0.14) per 1,000 persons-years, respectively. The incidence of a wrist fracture and ligament injury were 0.2 (0.13-0.25) and 0.1 (0.04-0.12) per 1,000 persons-years, respectively. There is a large difference between the number of patients presenting to the GP with hand and wrist complaints and the number of hand and wrist diagnosis reported in the medical files. Introducing specific ICPC codes for different types of hand and wrist disorders could (potentially) lead to a more accurate registration of a diagnosis and determination of the incidence figures.

What is known from the existing literature about the treatment of Mallet Injury using 3D printed splints? A Scoping Review Protocol

Background Mallet finger injuries are a frequent cause of hospital attendance, being the fifth most common injury in the body. They are therefore a frequent cause of hospital visits. To date, these injuries have primarily been managed using generic splints. As a generic splint provides a generic fit, patients who receive these are not provided with a custom splint experience. As the size and fit of these splints are not bespoke to the patient’s anatomy, patients may not always find the fit comfortable and may find complying with these splints difficult at times. However, an opportunity is developing within healthcare where custom splinting can be obtained for some using Three-D (3D) printing. The rationale for this review is to gain an understanding of the research that has been conducted on 3D printing of mallet injury splints. Objective The objective of this scoping review is to map the current literature on 3D printing associated with mallet finger injury. Methods The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used throughout along with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Two researchers will search the databases that will include CINAHL, Embase, Cochrane, EbscoHost, Medline/Pubmed, Science Direct, Web of Science, and Google Scholar. The search will include grey literature and a hand search of sources falling outside the chosen databases. Screen titles, abstracts, and full-text articles will be reviewed by two researchers independently using Rayaan software. The data extracted from the literature will first be presented in a tabulated chart followed by a narrative synthesis. Registration The protocol was registered on 6th September 2023, with the Open Science Framework. Registration DOI: https://doi.org/10.17605/OSF.IO/FSJPK

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

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. 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 ± 1.68years) 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. 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. 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.

Evaluating the clinical benefit and acceptance of a bespoke 3D-printed splint for the treatment of mallet finger injury: A pilot study in a cohort of patients

Mallet finger injuries due to forced flexion of the distal interphalangeal joint represent a common reason for hospitalization. These injuries are primarily managed using generic Stack splints. The gold standard of care is custom splinting by a specialized hand therapist. However, this is not widely available due to staffing constraints. The aims of this study are to: (i) evaluate whether treating mallet finger injuries with a custom three-dimensional (3D)-printed splint is clinically beneficial, and (ii) assess patient and healthcare professional (HCP) acceptance and experience of bespoke 3D-printed mallet splints over generic splints. Ten adult patients with closed mallet finger injury were recruited in this study, which was conducted across three Injury Units in the University of Limerick Hospital Group (ULHG). Each patient&amp;rsquo;s injured finger was measured using calipers and subsequently fitted with a bespoke 3D-printed splint. Clinical benefit and acceptance of bespoke 3D-printed splints for the treatment of mallet finger injury was assessed. The results indicate that it is clinically advantageous to use a custom 3D-printed splint over a premolded generic splint. Out of the ten patients recruited, eight had successful outcomes based on the occupational therapist (OT) measurements using the Crawford classification scale. The results showed that 40% of patients scored excellent, 30% good, 30% fair, and 0% poor. In addition, in terms of patient and HCP acceptance of the splint, nine of the ten patients stated that they would use the 3D-printed custom splint again, if needed, in the future. In conclusion, a high level of patient and HCP acceptance signifies the clinical advantage of using 3D-printed splints. This pilot study shows that advances in 3D printing could make custom splinting a viable option for use in personalized healthcare.

A Novel Prolene Suture Pull-out Technique Combined with Anchor Technique for the Treatment of Tendinous Mallet Finger.

Mallet finger deformity is a prevalent disability that causes discomfort and inconvenience to the patients. Despite the existence of various surgical approaches, surgical management remains a controversial subject. We retrospectively analyzed the clinical data of 26 patients with isolated tendinous mallet fingers who were admitted between January 2021 and June 2022. Among them, there were 18 men and eight women, aged between 20 and 56 years, with an average age of 38 years. The causes of injury were cutting injuries (15 cases), sports impact injuries (nine cases), and sprains (two cases). The time interval between injury and surgery ranged from 2 hours to 48 days, with an average of 12 days. During the surgical procedure, the distal interphalangeal joint was fixed in a mild dorsiflexion position using Kirschner wire. Absorbable anchors were used to assist in the reconstruction of the insertion point of the finger extensor tendon. Additionally, a 4-0 Prolene suture was used for reinforcement. All 26 patients were followed up for a period ranging from 6 to 24 months, with an average follow-up duration of 9 months. The function of distal interphalangeal joint was preserved. According to the Crawford functional evaluation criteria, the function of the affected fingers was excellent in 15 cases, good in eight cases, fair in three cases, and poor in no cases. A novel Prolene suture pull-out technique is an effective approach to repair tendon mallet finger and reconstruct the tendon-bone anatomical unit. This treatment option provides favorable outcomes, with high rates of excellent and good functional results.

Investigation of the barriers to and functional outcomes of telerehabilitation in patients with hand injury

BackgroundTelerehabilitation is an approach that is growing in importance and rapidly becoming more prevalent. However, the potential barriers to this approach and its effectiveness relative to face-to-face treatment still need to be determined. PurposeThe aim of this study was to investigate the technology and access barriers, implementation and organizational challenges, and communication barriers faced by patients undergoing postoperative telerehabilitation after hand tendon repair surgery. It also aimed to investigate the effect of telerehabilitation on pain, kinesiophobia, and functional outcomes. Study designProspective, open-label, nonrandomized comparative clinical study. MethodsThe study was conducted with 44 patients who underwent tendon repair surgery due to tendon injuries of the extrinsic muscles of the hand. Participants were divided into two groups (face-to-face group and telerehabilitation group). All participants received three physiotherapy sessions per week for 8 weeks from their surgery (via video conference using mobile phones to the telerehabilitation group). An early passive motion protocol was applied for flexor tendon and zone 5-7 extensor tendon repairs. Mallet finger rehabilitation was performed for zone 2 extensor tendon repairs, while an early active short arc approach was used for zone 3-4 repairs. The telerehabilitation and face-to-face groups received the same treatment protocols three times a week. In the eighth week of treatment (in the 24th session), the Turkish version of the Arm, Shoulder, and Hand Injury Questionnaire (DASH-T) and Tampa Scale for Kinesiophobia were administered to all patients. The telerehabilitation group also underwent a barrier questionnaire. A pretreatment assessment could not be conducted. The independent-sample t-test was used for DASH-T data, and the Mann-Whitney U-test was used for Tampa Scale for Kinesiophobia to compare groups. ResultsIn the study, there were 24 participants (age: 31.58 ± 12.02 years) in the face-to-face group and 20 participants (age: 39.25 ± 12.72 years) in the telerehabilitation group. The two groups were similar in terms of DASH-T and pain (p = 0.103, effect size = 0.647, and p = 0.086, effect size = 0.652, respectively) in the 8 weeks. However, the telerehabilitation group had a higher fear of movement (p = 0.017, effect size = 3.265). The most common barriers to telerehabilitation practices were the fear of damaging the tendon repair and the need for help during the treatment. ConclusionsWe determined that face-to-face treatment in acute physiotherapy for patients who have undergone tendon repair may be more effective compared to telerehabilitation, as it appears to be less likely to induce kinesiophobia. However, in situations where face-to-face treatment is not possible (such as lockdown), telerehabilitation can also be preferred after at least one in-person session to teach and perform exercises.

An adjustable and customised finger splint to improve mallet finger treatment compliance and outcomes

ObjectiveTendinous mallet finger injuries are normally treated conservatively by finger splinting, whereby the injured finger is immobilised in extension to allow the ruptured extensor tendon to heal. However, current splints including the Stack and Zimmer reported high failure rates of almost 50 %. Reasons are attributed to poor splint fit, skin complications and discomfort which cause non-compliance to splint regimens. To address the above mentioned issues, we designed and developed a 3D printed adjustable and customised finger splint. Participants and interventionsThe 3D printed finger splint, Zimmer and Stack splint were worn by 24 healthy volunteers on their middle fingers for 24 h. Main outcome measuresThe finger extension angle, splint fit, splint comfort and skin maceration were assessed via angle measurement and subjects’ feedback using a questionnaire. ResultsThe 3D printed finger splint was capable to maintain the distal interphalangeal joint at an extended angle of 8.1° However, 70.8 % of the subjects reported that the 3D printed finger splint shifted or came off wholly during 24 h of wear. This proportion is higher compared to the Zimmer (45.8 %) and the Stack (37.5 %). While 91.7 % of the subjects were satisfied with the ease of wearing and removing the 3D printed finger splint, subjects experienced difficulty performing work and washing activities owing to the design and material. ConclusionOur proposed design fulfils its function of holding the fingertip in extension and improves ease of application. The design of 3D printed finger splint could be further refined to provide better splint fit and comfort, so as to achieve better treatment compliance.

Surgical Treatment of the Bony Mallet Injuries with Augmented Extension Block Technique: Clinical Outcomes of a New Modification

Surgical Treatment of The Bony Mallet Deformity with Augmented Extension Block Technique: Clinical Outcomes of a New Modification Introduction: Mallet finger deformity is a common pathology and the ‘Extension Block Technique’, is one of the most popular surgical techniques for the treatment of this condition. However, several complications may occur with this method such as fixation failure, compression failure of the dorsal part and loss of reduction. In the current study, it is aimed to report the result of our modification which is augmented extension block technique. Materials &amp; Method: The medical records of patients, who were operated with the diagnosis of bony mallet finger between 2015 and 2021, were evaluated retrospectively. Demographic data, mechanism of trauma, duration of operation, time from injury to surgery, follow-up period, implant removal time, and postoperative complications were collected from hospital records. Patients aged between 18 - 65 years who had been operated with augmented extension block technique with a minimum follow-up period of 6 months were included in the study. A total of 10 patients who met these criteria constituted the study group. Radiological evaluation of the cases was performed with anteroposterior and lateral radiographs. Range of motion and presence of pain were questioned and these data were evaluated according to Crawford criteria. Results: The mean age of the all patients was 40.2 ± 10.9 (range, 24-56) years. The mean follow-up period was 39.6 ± 26.7 (range, 13-76) months. Complete union was achieved in all patients on the final follow-up radiographs. According to Crawford evaluation criteria, the results were ‘excellent’ in six of the patients and ‘good’ in four of them. There were no patients with loss of flexion however, 5° extension loss was observed in four of the subjects. Discussion: This study demonstrates that the augmented extension block technique is a suitable option for the surgical treatment of bony mallet cases with lower complication rate and successful functional results. This modification can be considered as an alternative option for traditional extension block technique which avoids some related complications as postoperative reduction loss, rotational instability and extension loss. Keywords: Mallet finger, Bony mallet, Extension Block

Customizable Hyperextension Splint for Mallet Finger.

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. 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. 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.

Functional and radiological outcome of mallet finger fixation with extension block wiring

Functional and radiological outcome of mallet finger fixation with extension block wiring

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.

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.

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

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. 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. 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. 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.

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

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. 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. 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. 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.