Casting orthosis for mallet finger yielded fewer skin complications vs splint
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Results showed an association of fewer skin complications and less orthotic-related pain with use of a casting orthosis for mallet finger immobilization compared with a traditional thermoplastic splint.
Michael Rivlin, MD, FAAOS, and colleagues randomly assigned 58 patients with acute bony or soft tissue mallet finger to be treated with immobilization with either a thermoplastic, custom fabricated splint or a casting orthosis (QuickCast, Rolyan). Researchers evaluated patients at 3, 6 and 10 weeks for acute bony mallets and at 4, 8 and 12 weeks for soft tissue mallets. At each follow-up visit, patients and the treating physicians completed evaluation forms, and researchers compared skin complications, pain with orthosis, compliance and final extensor lag between the two groups.
Regardless of whether a patient had a bony or soft tissue mallet injury, results showed patients treated with the casting orthosis had fewer skin complications and less pain compared with the thermoplastic, custom fabricated splint group. Subgroup analysis results showed an even greater difference in perceived pain, favoring the casting orthosis over the splint group among patients with soft tissue mallet finger. Researchers found no significant differences with cast/splint care difficulty and wear pattern or in final extensor lag between the use of the casting orthosis and the splint. Physicians reported no significant differences in skin complications, patient complaints or final extensor lag between the casting orthosis and splint groups, according to physician survey data.
“Overall, QuickCast immobilization for the treatment of acute soft tissue and bony mallet fingers seems to be more comfortable and is associated with fewer skin complications than fabricated splints likely due to its better fit, subsequently keeping patients more compliant with its use,” Rivlin, hand and wrist surgeon at Rothman Orthopaedic Institute, told Healio Orthopedics. “QuickCast for the treatment of bony and soft tissue mallet injuries is effective and preferred by most patients compared to thermoplastic splints.” – by Casey Tingle
Reference:
Cavanaugh PK, et al. ePaper 460. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Rivlin reports he is a board or committee member for the American Society for Surgery of the Hand; is on the editorial or governing board for Archives of Bone and Joint Surgery, HAND and Journal of Hand Surgery – American; has stock or stock options in Dimension Orthotics; receives IP royalties and is a paid consultant for Miami Device Solutions; and is a paid presenter or speaker for Seg-way.
Perspective
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Kimberly McVeigh, MBA, OTR/L, CHT
As a practicing certified hand therapist for more than 20 years, mallet finger is one of the more common injuries I have seen and they are a challenge to immobilize effectively until healing. The challenges are skin integrity, frequent water exposure, daily changes in edema and limiting immobilization to the distal interphalangeal joint.
Upon review of the literature, there are many randomized control trials with comparisons of surgical correction to custom orthotics and custom orthotics compared to off-the-shelf orthotics. All studies consistently examine extensor lag and skin complications as a standard outcome measure. This study uniquely addressed two different custom orthosis applications, not only for extensor lag and skin complications, but for pain and compliance as well.
Recent research has supported longer immobilization for soft tissue vs. bony mallet fingers, as addressed in this study. Although this article could benefit from a higher number of study participants, longer-term follow-up and an additional group treated with off-the-shelf orthotics, the results of this randomized controlled trial validates our institution’s anecdotal experience of improved comfort, compliance and outcomes with circumferential cast immobilization compared to custom thermoplastic and/or off-the-shelf orthotics.
Mayo Clinic
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