Extension Block Pinning vs Conservative Treatment for Mallet Finger Fractures

Haseki Training and Research Hospital62 enrolled

Overview

Mallet finger fractures are injuries affecting the tip of the finger and can be treated either with splinting or surgery. However, there is no clear agreement on which treatment provides better outcomes for certain types of these fractures. In this study, patients with mallet finger fractures were randomly assigned to receive either surgical treatment using a pin-orthosis extension-block pinning technique or conservative treatment with splint immobilization. Patients were followed at regular intervals, and outcomes such as finger movement, function, bone healing, and complications were evaluated over time. The purpose of this study is to compare these two treatment approaches and determine which one leads to better clinical and functional outcomes.

Mallet finger fractures, particularly those involving a significant portion of the distal interphalangeal joint articular surface, present a therapeutic challenge, and there is no consensus regarding the optimal treatment strategy. Both conservative management with splinting and various surgical techniques have been described in the literature. This randomized controlled trial was designed to compare the clinical and radiographic outcomes of the pin-orthosis extension-block pinning technique and conventional conservative treatment in patients with mallet finger fractures. Patients were randomly assigned to either surgical or conservative treatment groups and followed at regular intervals. Clinical and functional outcomes were assessed throughout the follow-up period to evaluate the effectiveness and safety of both treatment approaches."

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Interventions

Pin-Orthosis Extension-Block Pinning TechniquePROCEDURE

The pin-orthosis extension-block pinning technique was performed under appropriate anesthesia. A Kirschner wire was used to block extension at the distal interphalangeal joint and stabilize the fracture fragment, followed by immobilization with an orthosis. The fixation was maintained for a defined period, and patients were followed according to the study protocol.

SplintingPROCEDURE

Conservative treatment consisted of continuous splint immobilization of the distal interphalangeal joint in extension. Patients were instructed to maintain uninterrupted splint use for the recommended duration with regular follow-up visits to monitor compliance and clinical progress.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 18 and 65 years * Acute mallet fracture (≤ 3 weeks from injury) * Fracture fragment involving 20-50% of the distal interphalangeal (DIP) joint articular surface Exclusion Criteria: * Open fractures * Chronic mallet fractures (\> 3 weeks from injury) * Fracture fragment involving more than 50% of the DIP joint articular surface * Open physes * Inability to complete 12-month follow-up

Outcomes

Primary Outcomes

Distal Interphalangeal Joint Extension Lag

Degree of extension lag at the distal interphalangeal joint measured using a goniometer.

Time frame: 12 months

Secondary Outcomes

Distal Interphalangeal Joint Range of Motion

Range of motion of the distal interphalangeal joint measured in degrees.

Time frame: Up to 12 months (assessed at 2 weeks, 4 weeks, 6 weeks, 3 months, 6 months, and 12 months)

Functional Outcome According to Crawford Criteria

Functional outcome assessed using the Crawford classification system.

Time frame: 12 months

Fracture Union

Radiographic evidence of fracture healing assessed during follow-up.

Time frame: Up to 12 months (assessed at 6 weeks, 3 months, 6 months, and 12 months)

Complication Rate

Incidence of treatment-related complications observed during the study period.

Time frame: Up to 12 months