The Importance of Active Exercise in Treatment of Tendinous Mallet Finger: Insights From a Randomized Controlled Clinical Trial.

Abstract

Purpose: Tendinous mallet finger lacks high-level evidence guiding optimal treatment. In this study, we compared the results of thermoplastic splints with those of surgical treatment using Kirschner wire (K-wire) fixation in the management of tendinous mallet finger injuries.

Method: Forty-eight patients were enrolled and randomly assigned to the thermoplastic splint group (n = 23) and K-wire group (n = 25). An evaluation was performed 16 weeks after treatment, mainly focusing on DIP joint extension and flexion angles, and extension lag. The results were graded using the Abouna-Brown and Crawford scores, and factors affecting the outcomes were analyzed.

Results: There was no significant difference in the outcomes between the groups in terms of final extension and extension lag after 16 weeks. The final extension of the DIP joint in both groups correlated with the extension degree under fixation (R = 0.60) and the maximal extension of the contralateral fingers (Rho = 0.54). Slight extension loss was observed in the early stage after the removal of the form of immobilization (K-wires or splints), which was partially improved by routine active exercise.

Conclusions: Both K-wire fixation and thermoplastic splinting are effective treatments for tendinous mallet fingers, showing similar patterns of DIP joint extension loss and recovery during rehabilitation. Sustained active exercise appears to support DIP joint extension recovery.

Type of study/level of evidence: Therapeutic II.