Conservative management of mallet injuries: A national survey of current practice in the UK

Over a 4-year period, 218 mallet fractures in 211 adult patients were treated using a custom-made thermoplastic splint. Clinical results were collected prospectively, including the visual analogue score for pain, the range of motion and extensor lag, and the Patient Evaluation Measure (PEM). The joints were congruent in 168 and subluxed in 50. There were no differences in range of movement, extensor lag or PEM associated with articular subluxation or the size of the articular fragment. Pre-existing joint degeneration did not influence outcome. Non-surgical treatment demonstrates predictably good outcomes regardless of fragment size or subluxation in most patients and should be considered when discussing treatment for patients with bony mallet fractures. Level of evidence: III

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“…Tolkein et al. (2017) suggested that Patient-Reported Outcome Measures (PROMs) are important after conservative mallet finger treatment.…”

Section: Discussionmentioning

confidence: 99%

The non-operative management of bony mallet injuries

Trickett

Brock

Shewring

2021

J Hand Surg Eur Vol

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“… 15 The survey response rates were markedly higher than a comparable study from our network investigating preferences for managing mallet finger injuries. 16 The collaborative model improved survey methodology through collection of denominator lists and by directly engaging clinicians and patients when completing the survey.…”

Section: Discussionmentioning

confidence: 99%

Buried Versus Exposed Kirschner Wires Following Fixation of Hand Fractures: l Clinician and Patient Surveys

Gardiner¹,

Gardiner²,

Issa³

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Fractures of the metacarpals and phalanges are common. Placement of Kirschner wires (K-wires) is the most common form of surgical fixation. After placement, a key decision is whether to bury the end of a K-wire or leave it protruding from the skin (exposed). A recent systematic review found no evidence to support either approach. The aim of study was to investigate current clinical practice, understand the key factors influencing clinician decision-making, and explore patient preferences to inform the design of a randomized clinical trial.Methods:The steering group developed surveys for hand surgeons, hand therapists, and patients. Following piloting, they were distributed across the United Kingdom hand surgery units using the Reconstructive Surgery Trials Network.Results:A total of 423 hand surgeons, 187 hand therapists, and 187 patients completed the surveys. Plastic surgeons and junior surgical trainees preferred to leave K-wires not buried. Ease of removal correlated with a decision to leave wires exposed, whereas perceived risk of infection correlated with burying wires. Cost did not affect the decision. Hand therapists were primarily concerned about infection and patient-related outcomes. Patients were most concerned about wire-related problems and pain.Conclusion:This national survey provides a new understanding of the use of K-wires to manage hand fractures in the United Kingdom. A number of nonevidence-based factors seem to influence the decision to bury or leave K-wires exposed. The choice has important clinical and health economic implications that justify a randomized controlled trial.

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“…Mallet injuries result from disruption of the extensor tendon mechanism at the distal interphalangeal (DIP) joint either due to tendon rupture of soft tissue mallet or avulsion of the insertion of the tendon, leading to the inability to extend the DIP joint. 1 Seventy-four percent of bony mallet finger injuries involves the dominant hand, and more than 90% of injuries was found in the ulnar 3 digits. 2 Treatment for Doyle I could be challenging due to the fact that patients will accidentally pull Stack splint (type I).…”

Section: Introductionmentioning

confidence: 99%

Stack Splinting Versus Kirschner Wire Treatment in Acute Closed Mallet Finger Doyle I

et al. 2021

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Introduction: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is still unclear. Objective: To evaluate the treatment efficacy of Stack Splinting compared to a Kirschner wire immobilization of acute closed mallet finger Doyle I. Methods: From March 2019 to February 2020, 41 patients with acute close mallet finger Doyle I were treated; 19 patients were treated with Kirschner wire and 22 with Stack splinting for a mean of 6 weeks. The average patient age at the time of the injury was 43 years. Results: Twenty-eight males and 13 females were in this study. Among them, 17 patients were injured in the little finger, 15 in the middle finger, and 9 in the ring finger. Twenty-seven of injuries suffered an aggression, 11 from falling, and 3 from sports injuries. All the fingers had typical mallet malformation. Seventeen patients treated with Kirschner wire completed the treatment with full recovery, only 7 patients treated with Stack splint completed the treatment and 15 treated with Stack splint had relapse on mallet injury. Conclusion: Kirschner wire treatment is a simple procedure, and proves in this study that has better results in patients with acute closed mallet finger Doyle I compared to Stack splint.

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Conservative management of mallet injuries: A national survey of current practice in the UK

Cited by 9 publications

References 13 publications

The non-operative management of bony mallet injuries

The non-operative management of bony mallet injuries

Buried Versus Exposed Kirschner Wires Following Fixation of Hand Fractures: l Clinician and Patient Surveys

Stack Splinting Versus Kirschner Wire Treatment in Acute Closed Mallet Finger Doyle I

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