Orthotic Intervention with Custom-made Thermoplastic Material in Acute and Chronic Mallet Finger Injury: A Comparison of Outcomes

Document Type : RESEARCH PAPER


1 University of Western Ontario, London, Ontario, Canada

2 2 Assistant Professor, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 3 University of Western Ontario, London, Ontario, Canada

3 Reconstructive and Microsurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran



Objectives: To compare the effect of using custom-made orthosis on improving extension lag and reducing disability 
in acute and chronic mallet fingers.
Methods: We recruited 51 patients with acute or chronic Doyle type-1 mallet fingers, who were provided with a 
custom-made thermoplastic anti-mallet finger orthosis to wear full-time for 6 weeks and an additional 2 weeks at 
nighttime. The primary outcome, extension lag, was assessed at enrollment as well as six- and twelve-week followups. Secondary outcomes included disability and satisfaction, which were evaluated using the Disability of the Arm, 
Shoulder, and Hand questionnaire at enrollment and 12 weeks, and a satisfaction scale at 12 weeks follow-up. Data 
analysis was conducted using univariate analysis of variance (ANOVA), one-way repeated measure mixed model 
analysis of covariance (ANCOVA), and independent sample t-test.
Results: A total of 43 participants, 25 acute and 18 chronic mallet fingers, completed the 12-week evaluation. The 
study found no significant difference between the two groups in terms of improvement in extension lag at either 
follow-up time point (P=0.21). Disability improved in both the acute and chronic groups at follow-up (P<0.05). 
Additionally, both groups expressed satisfaction with the treatment outcome, and no statistically significant 
difference was observed (t=0.173, P=0.51). We could not identify any clinically significant difference between the 
two groups in regard to extension lag, disability, or satisfaction at follow-up. Notably, 96% of the patients in the acute 
group and 88% of the patients in the chronic group demonstrated good to excellent outcomes. 
Conclusion: Orthotic intervention with custom-made thermoplastic material in acute and chronic mallet fingers 
improved extension lag and disability, and both groups were satisfied with the treatment outcomes. The findings of 
our study indicated that patients with chronic mallet fingers benefited from orthotic interventions in the same way 
that patients with acute mallet fingers did.
 Level of evidence: II


Main Subjects

  1. Bendre AA, Hartigan BJ, Kalainov DM. Mallet finger. J Am Acad Orthop Surg.2005; 13(5):336-44. doi: 10.5435/00124635-200509000-00007.
  2. Doyle JR: Extensor tendons—acute injuries, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY: Churchill Livingstone, 1999, pp 1962-1987.
  3. Moradi A, Kachooei AR, Mudgal CS. Mallet fracture. J Hand Surg Am.2014; 39(10):2067-9. doi: 10.1016/j.jhsa.2014.06.022.
  4. Smit JM, Beets MR, Zeebregts CJ, Rood A, Welters CF. Treatment options for mallet finger: a review. Plast Reconstr Surg.2010; 126(5):1624-1629. doi: 10.1097/PRS.0b013e3181ef8ec8.
  5. Pratt AL. Is eight weeks' immobilisation of the distal interphalangeal joint adequate treatment for acute closed mallet finger injuries of the hand? A critical review of the literature. The British Journal of Hand Therapy. 2004; 9(1):4-10.
  6. Facca S, Nonnenmacher J, Liverneaux P. [Treatment of mallet finger with dorsal nail glued splint: retrospective analysis of 270 cases]. Rev Chir Orthop Reparatrice Appar Mot. 2007; 93(7):682-9. doi: 10.1016/s0035-1040(07)73253-1.
  7. Botero SS, Diaz JJH, Benaïda A, Collon S, Facca S, Liverneaux PA. Review of acute traumatic closed mallet finger injuries in adults. Arch Plast Surg.2016;43(2):134-44. doi: 10.5999/aps.2016.43.2.134.
  8. Lin JS, Samora JB. Surgical and nonsurgical management of mallet finger: a systematic review. J Hand Surg Am.2018; 43(2):146-163.e2. doi: 10.1016/j.jhsa.2017.10.004.
  9. Lin JS, Samora JB. Outcomes of splinting in pediatric mallet finger. J Hand Surg Am.2018; 43(11):1041.e1-1041.e9. doi: 10.1016/j.jhsa.2018.03.037.
  10. Pike J, Mulpuri K, Metzger M, Ng G, Wells N, Goetz T. Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger. J Hand Surg Am.2010; 35(4):580-8. doi: 10.1016/j.jhsa.2010.01.005.
  11. Farzad M, Layeghi F, Asgari A, Ring DC, Karimlou M, Hosseini SA. A prospective randomized controlled trial of controlled passive mobilization vs. place and active hold exercises after zone 2 flexor tendon repair. Hand Surg.2014; 19(1):53-9. doi: 10.1142/S0218810414500105.
  12. Shafiee E, Farzad M, Karbalaei M. A Systematic Review of Self-Reported Outcome Measures Assessing Disability Following Hand and Upper Extremity Conditions in Persian Population. Arch Bone Jt Surg.2021;9(2):141-151. doi: 10.22038/abjs.2020.48859.2423.
  13. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg Am.1984; 9(2):231-7. doi: 10.1016/s0363-5023(84)80148-3.
  14. Gray CD, Kinnear PR,eds. IBM SPSS statistics 19 made simple. 1st ed.uk. Psychology Press; 2012.
  15. Peng C, Huang RW, Chen SH, et al. Comparative outcomes between surgical treatment and orthosis splint for mallet finger: a systematic review and meta-analysis. J Plast Surg Hand Surg.2023; 57(1-6):54-63. doi: 10.1080/2000656X.2022.2164291.
  16. Habib AE, Atiyya AN, Aly AM. Conservative versus Surgical Treatment in Management of Closed Mallet Finger: A Systematic Review and MetaAnalysis. QJM: An International Journal of Medicine. 2021; 114(Supplement_1):hcab104.
  17. Cavanaugh PK, Watkins C, Jones C, Maltenfort MG, Beredjiklian PK, Rivlin M. Effectiveness of Quickcast versus custom-fabricated thermoplastic orthosis immobilization for the treatment of mallet fingers: a randomized clinical trial. Hand (N Y).2022; 17(6):1090-1097. doi: 10.1177/1558944720988136.
  18. Duarte A. Optimising the conservative management of closed tendinous mallet finger injury. Emerg Nurse.2020; 28(5):35-40. doi: 10.7748/en.2020.e1974.
  19. Kinninmonth AW, Holburn F. A comparative controlled trial of a new perforated splint and a traditional splint in the treatment of mallet finger. J Hand Surg Br.1986; 11(2):261-2. doi: 10.1016/0266-7681(86)90276-7.
  20. Garberman SF, Diao E, Peimer CA. Mallet finger: results of early versus delayed closed treatment. J Hand Surg Am.1994; 19(5):850-2. doi: 10.1016/0363-5023(94)90200-3.
  21. Altan E, Alp NB, Baser R, Yalçın L. Soft-tissue mallet injuries: a comparison of early and delayed treatment. J Hand Surg Am.2014; 39(10):1982-5. doi: 10.1016/j.jhsa.2014.06.140.
  22. Aguillon A, Bang K, Heyman R, Hudak D, Spallino A. What is the Effect of Custom Fabricated Orthoses on Mallet Finger? Journal of Hand Therapy. 2018; 31(1):163-4.
  23. Valdes K, Naughton N, Algar L. Conservative treatment of mallet finger: a systematic review. J Hand Ther.2015; 28(3):237-45; quiz 246. doi: 10.1016/j.jht.2015.03.001.
  24. Jacobs MA, Austin NM, Austin NM. Orthotic intervention for the hand and upper extremity: splinting principles and process. Lippincott Williams & Wilkins; 2013.
  25. Cheung JP, Fung B, Ip WY. Review on mallet finger treatment. Hand Surg.2012; 17(3):439-47. doi: 10.1142/S0218810412300033.
  26. Handoll HH, Vaghela MV. Interventions for treating mallet finger injuries. Cochrane Database Syst Rev.2004 ;( 3):CD004574. doi: 10.1002/14651858.CD004574.pub2.