Digital splinting for acute closed bony mallet finger: A case series

Aim: To assess clinical, radiographic and functional outcomes of digital splinting in acute closed bony mallet finger injuries. Methodology: This Level IV case series included 19 patients with acute bony mallet finger. Patients with loss to follow-up, chronic injuries, open lesions, or unstable, irreducible, or clearly displaced distal interphalangeal (DIP) joint subluxations not corrected by splint positioning at presentation were excluded. All patients were treated with volar splint immobilisation of the DIP joint in extension for six weeks and followed for a minimum of 12 months. Extension deficit, range of motion, radiographic consolidation and classification (Wehbe and Schneider), and functional outcomes using the DASH score were assessed. Results: The average age of the patients was 33.6 years. The little finger was the most affected (52.6%). Most patients (84.2%) presented a fracture with an articular fragment greater than one-third of the articular surface. Overall satisfaction had a mean rating of 9.5 on a 0-10 scale (0 = lowest, 10 = highest). The mean DASH score was 4.3 ± 2.8. All fractures achieved bone consolidation, and no treatment-related complications were observed. Conclusions: Conservative digital splinting is a reasonable nonoperative option for acute bony mallet finger treated within four weeks of injury. Satisfactory consolidation and functional outcomes were observed in fractures with larger articular fragments and in selected cases of mild, splint-reducible distal interphalangeal joint subluxation. These findings do not extend to unstable or irreducible subluxations and should be interpreted within the constraints of a descriptive case series.