Mallet and Extension Relative Motion Splinting Trial

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The primary purpose of this study is to improve the healing of an injury to the extensor tendon of the finger known as ‘mallet finger’ by improved splinting. The disorder is caused by disruption of the extensor tendon to the most distal bone of the finger, resulting in an inability to fully straighten the finger. The current standard care for mallet finger injuries uses a splint that statically immobilises the most distal finger joint (DIPJ) in extension. However, in many patients the tendon heals slightly long, ending up with them losing the ability to fully extend their finger, known as a lag. Therefore, we propose using an additional splint that attaches to the adjacent (uninjured) fingers just beyond the knuckles and lifts the injured finger up slightly, known as an extension relative motion splint (ERMS). This results in the injured finger adopting a slightly flexed posture that relaxes the extensor tendon. We hypothesise that this will result in improved healing of the extensor tendon and therefore a reduced risk of lag. Importantly, the uninjured joints can still be fully straightened whilst wearing the ERMS, to prevent them becoming contracted in one position. This project will randomise around 60 patients to have either one (standard) or two (standard and ERMS) moulded plastic splints. The patients will also be stratified according to whether or not they have a small associated fracture. Splinting will be for eight weeks, with an additional two weeks if there is a lag noted after 8 weeks. The primary outcome will be extensor lag measured at two weeks after ceasing full time splinting. Secondary outcomes will be patient satisfaction, active range of motion (AROM) at the DIPJ, change in AROM at the proximal finger joint, total AROM of the finger, and complications.

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