The outcome difference between acute bony and tendinous mallet fingers treated conservatively in children

Tendinous and bony mallet are very different injuries presenting with extensor lag at the distal interphalangeal joint. This study is aimed to evaluate the outcome difference between acute bony and tendinous mallet fingers treated conservatively with a splint in children.

We collected retrospective data about patients at the time of injury with acute tendinous or bony mallet that were treated conservatively in our occupational therapy clinic. Patients were examined in the outpatient clinic. Pain, extension lag, and flexion loss were documented. Outcomes were classified according to the Crawford's criteria.

We collected data on 31 patients (16 bony and 15 tendinous mallet). We found the bony mallet patients to be older (mean 13.8 vs 11.9 years), We also found that tendinous mallet injuries affected predominantly the ring finger while bony mallet injuries affected predominantly the middle finger. Both bony and tendinous mallets tend to be more frequent in male. The extensor lag on initial was the same (median -18.5° vs -20°). As for the outcome, we found both groups to have excellent outcome in regard of the extension lag (median 0° vs 0° p = 0.538) and Crawford Criteria Assessment (p = 0.570).

Mallet injuries, either tendinous or bony, are not common in children. They are often studied together and typically treated in the same way with extension splintage. Yet, the evidence in adults clearly shows there are different injuries, which present in the same way. This study reinforces these findings in children regarding demographic findings but not for the treatment outcome.