Outcome Differences between Conservatively Treated Acute Bony and Tendinous Mallet Fingers

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Traumatology

Background:

• Tendinous and bony mallet fingers are distinct injuries affecting the distal interphalangeal joint's extensor mechanism.
• Both injury types often present with similar extensor lag, leading to combined study and treatment approaches.
• Conservative management with splinting is a common treatment for acute mallet fingers.

Purpose of the Study:

• To evaluate and compare the outcomes of acute bony versus tendinous mallet fingers treated conservatively with splints.
• To identify differences in patient demographics, injury characteristics, and treatment results between bony and tendinous mallet injuries.

Main Methods:

• Retrospective data collection from patients with acute tendinous or bony mallets treated conservatively.
• Data included pain, extension lag, and loss of flexion, assessed in an outpatient occupational therapy clinic.
• Outcomes were classified using the Crawford Criteria.

Main Results:

• 133 patients (43 bony, 90 tendinous) were analyzed.
• Bony mallet patients were younger (mean 36 vs. 46 years) and more likely female (60% vs. 34%).
• Tendinous mallets had worse initial extensor lag (median 28° vs. 15°), but bony mallets showed significantly better outcomes in extension lag (median 0° vs. 5°) and Crawford Criteria (p=0.004).

Conclusions:

• Despite similar presentation, bony and tendinous mallet fingers are different injuries.
• Conservative treatment yields superior outcomes for bony mallet fingers compared to tendinous mallet fingers.
• Findings support individualized treatment considerations based on mallet finger type.