Treatment of Mallet Finger; Conservative or Operative

Abstract

ABSTRACT:BACKGROUND:Mallet finger injuries, still represent a controversy as the best way of treatment, when to treat conservatively and when to go for surgical management . OBJECTIVE: This prospective study was undertaken to evaluate functional outcome of conservative versus surgical treatment of acute and chronic mallet finger injuries.PATIENTS AND METHODS:A prospective study was conducted between November 2011 and December 2013 . Forty six patients with mallet finger deformity were treated,21 by non-operative technique and 20 were treated surgically, the time between injury and commencement of treatment ranges from 3 days to 3 years mean ( 17 weeks).Follow up ranges from 12 months to 18 months mean( 15 months). RESULTS:Successful outcome was found in 57.15% of mallet fingers treated conservatively by splintage .patient satisfaction with conservative treatment was 66.7%. Successful outcome of surgical treatment was 65% while patient satisfaction was found in75% of cases treated surgically. Patients started conservative treatment within 4 weeks of injury had better outcome (success rate 81.8%) than those started treatment after 4 weeks (success rate 30%). Mallet finger injuries treated after 4 weeks from injury, show a better functional outcome in surgically treated group(success rate 61.5%), than injuries treated by splint (success rate 30%).CONCLUSION:Conservative treatment is safe, effective well tolerated, method of treatment for early closed and uncomplicated cases, with better outcome in patient started treatment within 4 weeks of injury than those started treatment after 4 weeks .Surgical treatment is required for open ,chronic cases and those complicated by swan neck deformity. Mallet injuries presented after 4 weeks show a better outcome if surgical treatment is undertaken.