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Outcomes of Splinting in Pediatric Mallet Finger
Journal article   Open access   Peer reviewed

Outcomes of Splinting in Pediatric Mallet Finger

James S. Lin and Julie Balch Samora
The Journal of hand surgery (American ed.), Vol.43(11), pp.1041.e1-1041.e9
11/01/2018
DOI: 10.1016/j.jhsa.2018.03.037
PMID: 29776724
url
https://doi.org/10.1016/j.jhsa.2018.03.037View
Published (Version of record) Open Access

Abstract

Purpose Excessive flexion at the distal interphalangeal (DIP) joint disrupts the extensor mechanism, leading to mallet finger injuries. The goal of management is to restore active DIP joint extension. We sought to learn which variables (treatment technique, injury type, time to presentation, adherence to treatment) affect clinical outcomes of pediatric mallet finger injuries. Methods A retrospective review was performed of patients who presented with mallet finger injuries during 2013 to 2017 at a large pediatric hospital. Patient characteristics, treatments, outcomes, and radiographic data were collected. Types of nonsurgical treatment, acute versus delayed (> 28 days) presentation, and compliant versus noncompliant patients were compared. Differences in extension lag and incidence of complications were evaluated. Results There were 94 patients with 99 mallet fingers, with a mean age of 13.7 years, 66 of whom were boys (70%) and 28 girls (30%). Most injuries occurred during recreation (78%). Ninety-nine percent of patients were treated nonsurgically with extension orthoses. The majority of injuries were bony mallets (80%). The outcomes resulted in a mean extension lag of 1 degrees. Of patients presenting acutely, residual extension lag and complications occurred in 12% and 9%, respectively; the lag and complication rate for patients presenting after a delay was 25% and 19%, respectively. Treatment adherence was associated with better clinical outcomes, with nonadherent patients more likely to experience a residual extensor lag (11% vs 67%) and potentially clinically relevant complications (8% vs 50%). Conclusions The majority of pediatric mallet finger injuries can achieve good outcomes with nonsurgical treatment. Absolute indications for surgery in this population remain unclear. Copyright (C) 2018 by the American Society for Surgery of the Hand. All rights reserved.
 Life Sciences & Biomedicine Orthopedics Science & Technology Surgery

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