Association between initial Angulation and Outcome in Closed Mallet Finger Treated Conservatively

Background: Mallet finger (MF) has a greater incidence in middle-age men¹. The current consensus for non-complicated closed Mallet finger is conservative treatment². The standardized immobilization period is between 6 and 8 weeks³. The Crawford classification (CC) divides outcomes in four stages: excellent, good, average and poor⁴. According to Altan, seventy two percent of the patients managed conservatively had an excellent result according to the CC⁵.

 

Objective: Our aim was to establish the frequency of patients achieving an excellent result with Mallet finger treated conservatively in a Tertiary-level Hospital in Mexico City.

 

Material and methods: The study was observational, prospective, descriptive and analytical. Patients chosen had an uncomplicated closed MF, during January to December of 2017. Two measures of the Distal Interphalangeal Joint (DIPJ) were done, at the initial trauma and 6 weeks after conservative treatment. All were ranked according to the CC. Analysis was made to determine most frequently affected gender, age group, hand and fingers. Furthermore, we compared the association between the initial angulation and the residual angulation of the DIPJ.

 

Results: We obtained 43 patients, of which 32 were male and 11 were female. More than half (55.8%) had an age ranging from 40 to 45 years. Right hand was affected in 58.1% and middle finger was the most affected (37.2%). Afterward six weeks, the outcomes obtained were excellent in 53.48%, good in 20.93%, average in 23.25% and poor in 2.32%. The sample was later divided in two groups; one that initially had <30° of DIPJ angulation and the other with >30°. In the first group 28% had a DIPJ residual angulation and the second had 72.22%. We find that above 30º, there is a Relative Risk (RR) to have residual angulation of 2.99 (1.73 – 25.8) with a statistically significant p of 0.0059.

 

Discussion: MF was more frequent in males, in the right hand and in the middle finger, this tally with international data. An adequate functional result was present in >70% of our sample (CC excellent and good). There is an increase in the frequency of the residual angulation in the patients with >30° initially in the DIPJ.

 

Conclusion: MF benefits from the conservative treatment in Mexican population. Further studies with a larger sample are needed to associate the initial DIPJ angulation and the results with conservative management. We suggest to evaluate other treatments for patients with more than 30º of initial angulation.

 

References:

1. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury 2009; 39:1338-44
2. Handoll HH, Voghela M. Interventions for treating mallet finger injuries. Cochrane Database Syst Rev. 2004;3:CD
3. Valdes K, Naughton N, Algar L. Conservative treatment of mallet finger: A systematic review. Journal of hand therapy. 2015, Pages 1-9.
4. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg Am 1984;9:231-7.
5. Altan E, Alp NB, Baser R, Yalçin L. Sotf-tissue mallet injuries: a comparison of early and delayed treatment. J Hand Surg Am 2014 Oct;39(19):1982-5.