International Perspectives on the Management of Acute Mallet Finger Injuries: A Cross-Sectional Survey

Background: Mallet fingers are common injuries with management often being guided by presence of fracture, joint subluxation, chronicity and patient requirements and surgeon preferences. The purpose of this study was to understand current trends of management of mallet finger injuries. Methods: This study surveyed an international group of English-speaking hand surgeons (n = 244) with different types of mallet finger injury patterns to assess current trends and identify any regional variations in practice. Results: Nonoperative management with extension splinting was the preferred treatment for soft tissue (93%) and congruent bony (87%) mallet finger injuries amongst surgeons from all regions. Similarly, most surgeons (76%) preferred operative treatment for incongruent bony injuries. The management of subtle joint subluxation was contentious with 36% recommending splinting and the rest opting for closed reduction and wiring or open reduction. Conclusions: While there is no consensus on treatment, surgeons seem to prefer nonoperative treatment for most soft tissue mallet injuries. Surgeon preference seems to dictate the management of bony mallet injuries especially with incongruent joints. Prospective randomised studies would be beneficial in providing evidence-based guidelines for management of this common injury. Level of Evidence: Level V (Therapeutic).