Efficacy of two splint treatment protocols of tendinous mallet finger Injuries

Current literature supports the conservative management over surgical management for type one tendinous mallet injuries (ie full or partial rupture of the terminal insertion of the extensor tendon in the finger). However the gold standard of conservative treatment is still under development and a topic for debate amongst researchers and clinicians. This study will include two groups: the 'Standard Care Group' will follow the 'standard' tendinous mallet splint protocol of a custom-made thermoplastic splint including and blocking the DIP joint in extension/hyperextension with the PIP joint free for eight weeks full time wear followed by four weeks of intermittent day wear and nocturnal wear. The 'Standard Care Group' data will be collected retrospectively. The 'PIP protocol group', will wear a custom-made thermoplastic splint which blocks the PIP joint in a controlled flexion range for the initial two-four weeks (determined by the natural laxity of the volar plate and hyperextension of the PIP joint) together with the DIP joint blocked in extension/hyperextension, before continuing with the 'standard' protocol for up to eight weeks of continuous splint wear followed by a further four weeks of protective and nocturnal wear. It is proposed that the 'PIP Protocol Group' data will be followed prospectively. All subjects will be asked at each treatment intervention regarding their adherence to the treatment protocol, and any diversions or changes noted. Proposed methodology: Quantitative methods will be used to compare the outcomes for the two treatment groups. Approximately 30 people will be recruited retrospectively to analyse outcomes of the standard treatment group. Approximately 30 people will be recruited prospectively for the PIP protocol group. Patients with a Zone One tendinous mallet finger injury, who fit the selection criteria and agree to participation in the study, will be allocated to a group – 'Standard care' or 'PIP protocol' care. In the initial phase all patients will be treated using the 'Standard care' group. This phase will continue for a period of three months or until a total of 30 patients is reached and will include retrospective clients who provide consent to access their records. Following completion of this phase, all subsequent patients will be allocated to the 'PIP protocol' group for a period of three months or until a total of 30 patients is reached for this group. The Occupational Therapy staff at Specialised Hand Therapy Service will conduct the standard treatment trial at any of their nine practice locations in Western Australia, with Dr Janet Richmond from ECU School of Medical and Health Sciences taking the chief investigator role. Data analysis will be conducted using SPSS. Correlations of outcomes will be investigated. Standard deviation and t-test statistics will be calculated to determine effect size and significance of the treatment protocol.