gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Alternative management of mallet finger injuries based on finger biomechanics

Meeting Abstract

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  • presenting/speaker Juliana Larocerie - Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Canada
  • Shrikant Chinchalkar - Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Canada

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSHT19-1255

doi: 10.3205/19ifssh1576, urn:nbn:de:0183-19ifssh15768

Published: February 6, 2020

© 2020 Larocerie et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Clinical issue/s: Mallet finger injuries have been classically treated by means of immobilization of the distal interphalangeal (DIP) joint in extension or slightly hyperextended for 6-8 weeks. Despite of the prolonged treatment, a 10 to 15 degrees of extension lag is considered acceptable. Nevertheless, even such a small degree of extension lag may create enough biomechanical imbalance to the intricate extension apparatus of the finger, potentially leading to fixed deformities, such as swan-neck.

The purpose of this case series is to present an alternative rehabilitation option for the treatment of mallet finger injuries, taking into consideration biomechanics of the extensor tendon mechanism, in the hopes of optimizing DIP joint extension and prevent finger deformities.

Clinical reasoning: Patients with acute mallet finger injuries were considered for this case series. Patients were provided with a finger-based cast or thermoplastic orthosis for 6-8 weeks, including the proximal interphalangeal (PIP) joint at approximately 30° of flexion and the DIPJ in neutral or slightly hyperextended. Measurements of DIP joint extension were taken with a finger goniometer.

Innovative, analytical or new approach: To date, a total of 19 patients with mallet finger injuries were treated in the Hand Therapy Dept of or centre. Patients age range from 14 to 86 years old, and there were 6 females and 13 males.

In average, patients were seen in Hand Therapy for 12 weeks. The total time of complete immobilization was in average 8 weeks. At the time of the last follow-up visit, patients demonstrated an average 3.15 ° of DIP joint flexion extension. PIP joint flexion and extension was the same as pre-injury.

Contribution to advancing HT practice: Treating mallet finger injuries with an orthosis that include both the PIP and DIP joints seems to be more effective in treating these injuries and preventing future deformities than treating the DIP joint alone.