This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem. The use of a 3-point prefabricated orthosis with elastic tape and cast are both appropriate immobilization options for the management of nonsurgical mallet finger.Ĭustom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. The overall findings for both treatment groups included means of <15° of extensor lag and minimal pain (mean, <1.2 of 10) at the 6-month outcome assessment. No statistically or clinically significant differences were found between the groups regarding distal interphalangeal joint extension lag, distal interphalangeal joint flexion deficits, function according to the brief Michigan Hand Outcome Questionnaire, and pain on the Numeric Pain Rating Scale.
Outcomes were assessed at 12 weeks after the initiation of full-time immobilization and 6 months after injury.Ī total of 70 individuals agreed to participate in the study between April 2017 and April 2021. Individuals with a mallet injury requiring nonsurgical management were randomized to 6 weeks of full-time immobilization with either a 3-point prefabricated orthosis and elastic tape or a cast for distal interphalangeal joint extension. This study was conducted in a single center.
#KENTUCKY DOCXTOR CATANZARO TRIAL#
The purpose of this randomized trial was to compare the outcomes of using a 3-point prefabricated orthosis with elastic tape versus cast immobilization for the management of nonsurgical mallet finger. Further evaluation with a larger cohort is warranted to increase the statistical power of the findings. Statistically significant risk factors for failure are increasing age, a tendinous injury, and the orthotic type. There was no significant difference in the orthotic management failure rate by digit for a mallet injury. The orthotic type was associated with the failure rate, and failure was highest in patients treated with Stack orthoses (n = 183, 56% P =. The failure rate was higher in tendinous versus bony mallet injuries (n = 131, 40% vs n = 66, 20%, respectively P <. The median patient age with failure was 54 years, versus the median patient age with nonfailure of 48 years ( P <. An older age at injury was associated with failure. There was a trend toward the little finger failing at a higher rate (n = 131, 40%) than the other digits individually ( P =. There was no statistically significant difference of failure rate between digits. Out of 1,331 identified patients, 328 met the inclusion criteria. A categorical variable analysis was performed to identify risk factors for failure of orthosis management. Failure rates were compared for all digits, specifically comparing the little finger versus all other digits. Patient demographics, details of management, and treatment outcomes were collected. This was a retrospective chart review of all patients with an isolated mallet finger injury managed at our institution from 2011 to 2019.
Our purpose was to report the failure rates of orthotic management by digit and investigate other factors that contribute to failure.
Nonsurgical treatment with continuous extension orthosis fabrication is the preferred treatment. Even patients who delay initiation of treatment can achieve favorable results.Ī closed mallet injury is a common finger injury involving terminal extensor tendon avulsion from its insertion on the distal phalanx. While increased age may negatively affect the final result of mallet finger injuries, an older individual can favorably influence his or her result by choosing to be compliant with treatment. Statistical analysis reveals that compliant patients have excellent outcomes more often than do noncompliant patients (61.5% and 9.1%, respectively) in the treatment for mallet finger injuries. Results of therapy were divided into excellent, good, or poor groups depending on the patient's final range of motion and final active extension lag at the distal interphalangeal joint. Compliance ratings were based on self-reports of performance with home programs and attendance at therapy appointments. The records of 44 patients who sustained mallet finger injuries were examined retrospectively. While patient compliance with hand therapy intuitively seems important to the outcome of treatment, no formal study has validated this assumption.
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