Non-surgical management of displaced bony mallet injuries using dorsal hyperextension splint: an early-term outcome analysis

Purpose: There is still controversy over the ideal treatment of acute bony mallet injuries. The purpose of this study was to evaluate outcomes of a dorsal hyperextension splint treatment for displaced bony mallet injuries. Methods: A retrospective review of a single institution database identified all acute displaced bony mallet injuries that were conservatively treated using dorsal hyperextension aluminum splint in a one-year period. In this method, each splint is custom-made and applied by a one surgeon at the clinic. The demographics, treatment process, complications, and outcomes were reviewed. Results: Seventeen patients (11 men, 6 women) with a mean age of 25.1 years (range 15–45) were enrolled. The mean treatment delay was 7 days (range 1–21). Radiographic healing was achieved in all patients at a mean duration of 5½ weeks (range 4–6 weeks). Early complications included the maceration, prolonged erythema in two patients and a partial thickness wound in one patient. The mean follow-up period was 22 months (range 17–26) for fifteen patients. Late complications included two slight swan neck deformities and one complex regional pain syndrome. Four patients had noticeable (>5°) extension lag between 6° and 11°. Two patients had intractable pain with Visual Analog Scale of 3 and 4 points. Overall, 12 out of 15 fingers were subjectively rated as good or excellent. Conclusion: Using a dorsal hyperextension splint, conservative treatment of displaced bony mallet injury provides overall good results in terms of union rates, patient outcomes, function, and few complications in a short term.