Clinical Trial: Comparison of Splinting Interventions for Treating Mallet Finger Injuries
Study Status: Recruiting
Recruit Status: Unknown status
Study Type: Interventional
Official Title: Comparison of Splinting Interventions for Minimising Extensor Lag in Mallet Finger Injuries
Brief Summary:
Stubbing of the finger-tip is a common injury in sports such as basketball, volleyball, cricket and football. This can result in a Mallet finger deformity, where the end joint of a finger cannot be actively straightened out. In most mallet finger cases seen at The Alfred, the skin remains intact, and the impairment results from a tear of the extensor tendon or an avulsion (a small fracture where the tendon attaches to the bone). Treatment commonly involves immobilising the end joint of the finger in a splint for six or more weeks so patient compliance is a major factor in the quality of the outcome achieved.
This study aims to compare two different types of splintage (the commonly used thermoplastic thimble splint and the aluminium-foam “Mexican hat” splint which is in use in Britain) with a control splint (thermoplastic prefabricated “stack splint” with tape). Outcome measures will include patient compliance with the splint, degree of extensor lag, active movement of the joint, and any complications.
The null hypothesis is that there are no differences in outcome between different methods of conservative splinting treatment for mallet finger.
Detailed Summary:
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Literature Review:
Mallet finger is defined as a loss of continuity of the distal insertion of the extensor tendon at the finger tip. It is a common hand injury in ball sports (McCue and Garroway 1985) but can also occur from minor incidents such as bed-making and trips/falls (Abouna and Brown, 1968). The injury results in a drooping of the distal inter-phalangeal joint, and is usually managed conservatively by splinting in hyper-extension for 6 or more weeks. This position allows relaxation of the tendon and encourages healing by bringing the torn ends or fracture fragments closer together during the healing phase.
A recent Cochrane Systematic review of the evidence in treating this injury (Handoll and Vaghela, 2005) found that there is insufficient evidence in existing randomised controlled trials to establish the effectiveness of different (either custom-made or off-the-shelf) finger splints for treating mallet finger injury. They commented that there were only 4 trials that met the inclusion criteria, and all of these were “small, heterogeneous, inadequately described and reported….and had methodological flaws”. Evidence provided is therefore an inadequate base for clinical decision making.
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Rationale for project:
If mallet injuries are not managed correctly, the patient can be left with a persistent extension lag (loss of voluntary straightening) and swan neck deformity (severe flexion deformity of distal finger joint plus a secondary hyperextension deformity of the proximal joint resulting from an imbalance in the extensor mechanism).
Mall
Sponsor: Bayside Health
Current Primary Outcome: Degree of extensor lag at distal inter-phalangeal (DIP)joint
Original Primary Outcome: Same as current
Current Secondary Outcome:
- Active range of motion at DIP
- Patient compliance with splinting regime, based on self-report (as described above)
- Patient satisfaction with result on 5-point likert scale
- Complications
- Pain, measured by 10 point Visual Analogue Scale
Original Secondary Outcome: Same as current
Information By: Bayside Health
Dates:
Date Received: April 2, 2006
Date Started: May 2006
Date Completion: September 2007
Last Updated: April 2, 2006
Last Verified: April 2006
