Objective:
Avulsion fracture of the extensor tendon from the distal phalanx is a common finger injury, commonly termed a ‘mallet fracture’.
We present a large prospective cohort study, designed to determine whether mallet fractures managed with splints, guided by hand therapists, have different outcomes to those managed surgically.
Method:
108 patients, with 113 bony mallet fractures were enrolled in this prospective cohort study. Patients were identified from multiple hand therapy units and 2 major teaching hospitals. The injuries were graded using the Wehbe and Schneider classification.
Patients were followed up in person at two intervals, approximately three-months and six-months post injury. The outcome was assessed using a multimodal assessment: radiographs, range of motion assessment and functional questionnaires
The primary outcome was a multifaceted assessment of ‘success’, which incorporated joint congruency, extensor lag and pain score. Individual outcome measures were also evaluated including loss of flexion, patient rated function and pain score. The results were analysed by two statisticians.
Results:
Of the 108 patients enrolled prospectively, 84 patients with 89 fractures completed the study; 43 were operated on and 46 managed conservatively with splinting.
The median follow up time was 174 days and 185days in the conservative and surgical group respectively.
Overall both treatments have a comparable rate of ‘success’ when all injury grades were included. 2B injuries have a significantly higher chance of early success if managed surgically. 1B fractures are more likely to succeed when managed conservatively. Reduction in range of motion occurs in both groups.
Conclusions:
Poorly managed mallet fractures can lead to long-term pain, deformity and loss of function. Care needs to be taken when choosing the intervention and when informing patients about treatment choices.
We hope that this large prospective study will aid surgeons and hand therapists who treat this common injury.