In search for the optimal treatment for mallet fingers

The standard treatment of an uncomplicated mallet finger in the Netherlands is
often a Stack splint worn for six weeks. During the initial consultation at the
emergency department patients are informed about their diagnosis and a splint
is fitted and applied. Patients are informed that the splint should be worn for
24 hours a day and should only be removed for skin care of the involved finger.
During removal of the splint, the finger should be placed on a flat surface to
prevent flexion in the distal in DIP joint. During this six week period the
patient can return once or twice to the outpatient clinic if preferred for a
checkup. After six weeks the splint is removed and patients are advised to
slowly start mobilization of the DIP joint.
A potential limitation of this treatment is that patients are, by the limited
check-ups and skin care involved, tempted to remove the splint and flectate the
DIP joint, disturbing the healing of tendon. Another potential limitation is
the mobilization which is not overseen by a professional. This can lead to a
too early or too late mobilization, resulting in an extensor lag or flexion
limitation, respectively, of the DIP joint.
To overcome these limitations patients we started to refer patient to the hand
therapy center. There a custom made splint is applied and check-ups are more
frequent. The splint is only removed by the therapist to prevent potential
problems of splint removal by the patient themselves. After the six weeks
period patient start gradually to mobilize the DIP joint under supervision of
the therapist.
At this moment both type of treatments, six week Stack splint and hand therapy
center, respectively, take place in the Catharina Hospital Eindhoven, The
Netherlands. The received treatment depends on the type of medical specialty by
whom the patient is evaluated on the emergency department. Patients with a
mallet finger are either seen by the department of plastic surgery or the
department of general surgery, this varies per day due to local agreements.

The evaluate which treatment of mallet fingers is better, the conventional
mallet therapy via the hospital or the personalized treatment with intensive
follow up via the handencentrum. This will be investigated for mallet fingers
caused by an extensor tendon rupture as well by an avulsion fracture.

The injury will be investigated whether it is due to an extensor tendon
rupture, or an avulsion fracture. Both injuries will be regarded and treated as
separate groups. These groups will be analysed via the same research protocol.
The study will be a randomized trial comparing the conventional mallet therapy
via the hospital and the personalized treatment with intensive follow up via
the handencentrum. The study will be performed at the Catharina Hospital,
Eindhoven, The Netherlands and the *Handencentrum*, Eindhoven, The Netherlands.
Recruitment will be initiated at the emergency department of the Catharina
Hospital.

The extra burden for participants compared to the *normal* treatment is that
they need to fill in multipele questionnaires, need to have an additional
X-rays taken (of the involved finger and the contralateral finger) and
additional out-patient clinic visit is required.
The filing in of the questionnaires and additional out-patient visit will
require time of the participants. The two additional X-rays will give a
radiation dose of <0.01 mSv. The authors are of opinion that this dose is so
small that it is to be neglected.