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Mallet Injuries - uncomplicated yet no clear consensus on best practice

Mallet finger, or thumb, is a common traumatic injury to the hand. Mallet injuries result from disruption of the extensor tendon mechanism at the distal interphalangeal joint (interphalangeal joint of the thumb) either due to tendon rupture (a soft tissue mallet) or avulsion (a bony mallet) leading to the inability to extend the distal interphalangeal joint. If untreated, a mallet injury may become chronic

leading to a swan neck deformity of the finger. On occasion, a Swan Neck Deformity may present soon after the injury.

Immobilisation with a splint is the most common conservative treatment for undisplaced, closed bony andclosed soft tissue mallet injuries, but there is a lack of consensus regarding the duration of immobilisation and the type of splint used. The conservative management of mallet injuries was evaluated by means of a national survey of current practice in the UK. The study found that different splint types were favoured by different speciality groups. For the management of soft tissue injuries, 43 (80%) therapists used a custom-made thermoplastic splint on the dorsal surface, compared with only 11 (20%) surgeons. Conversely, only 17 (18%) therapists used a plastic stacksplint compared with 76 (82%) surgeons. The splint preferences observed for the management of bony injuries were comparable to those of soft tissue injuries.

The study concluded that there is no consensus regarding the optimal conservative management of mallet finger in the UK and limited high quality evidence to support the best practice. The variation in the literature regarding the conservative management of mallet finger including recommended duration of protection immobilisation, time to discharge to GP, assessment of adherence to treatment and type of splint. Several systematic reviews including a Cochrane review have highlighted a lack of evidence about optimum splint type.

What is important is that therapists review the patient frequently to assess progress and adapt the splint design or positon accordingly. This will ultimately result in a favourable outcome.

Reference:(https://www.researchgate.net/publication/316411812_Conservative_management_of_mallet_injuries_A_national_survey_of_current_practice_in_the_UK[accessed Oct 17 2018].)

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