Report on Hands from Doctors Demystify, January 2012
CONTENTS
DD Courses, of course
Splinting mallet fingers
Happy birthday, Dr. Kienbock
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JOURNAL ARTICLE REVIEW
What type of brace works best for mallet finger?
Two hand therapists from Melbourne, Australia report their results from a rigorously
designed and executed prospective study comparing Stack, dorsal aluminum-foam, and
custom-molded thermoplastic splints for treatment of 64 mallet fingers, both tendinous
and those with small avulsion fractures. Splints, chosen by randomization, were worn for
8 weeks. Follow-up evaluation at 12 and 20 weeks included goniometric measurement of
active extension, pain, and patient satisfaction while looking for compliance, incidence of
treatment failure, and complications.
At 12 and 20 weeks a therapist, blinded to the type of splint used, obtained
measurements. There was no difference among the groups regarding extensor lag, which
averaged 20 degrees and did not differ significantly by specific finger injured. Treatment
failure, however, was 24% for both the Stack and aluminum splints and zero for the
custom splints. Patient satisfaction and pain did not differ among the groups. Greater
compliance led to better results. Women and younger patients fared better than others.
Smoking status and tendon vs. bone injury made no difference.
The 19 complications in the Stack group were principally skin irritation and poor fit. The
8 complications in the aluminum group were principally skin irritation and
dissatisfaction. The 5 complications in the custom group were principally splint cracking,
which the patient corrected with tape until the splint could be remade.
Comment: Although I think I could have predicted the results, it is nice to see a carefully
designed and executed, prospective, blinded study. Stack splints, despite the multiple
sizes, always seem to be just a little too small or a little too big. They also tend to trap
moisture, and the skin gets stinky. Aluminum-foam splints also trap water and foster
microorganism growth. Both Stack and aluminum splints require tape, which quickly
becomes soggy and dirty. The investigators used 1/16” microperforated Orfit for the
custom splint, which covered the finger, thimble-like, from tip to base of middle phalanx.
I prefer a custom-molded splint, but the design I use leaves the pulp exposed so the
patient can continue with keyboard activities. Moisture accumulation is not a problem
Have a look at the Mallet Mender Splint at www.freehandbrace.com
O’Brien L, Baily, M: Single blind, prospective, randomized controlled trial comparing
dorsal aluminum and custom thermoplastic splints to Stack splint for acute mallet finger.
Arch Phys Med Rehabil 2011, 92:191-198
abstract: http://www.ncbi.nlm.nih.gov/pubmed/21272714
HAPPY BIRTHDAY, DR. KIENBOCK
Robert Kienbock (1871-1953) earned his medical degree in 1895, the same year that the
Roentgens discovered x-rays. Kienbock worked in Vienna in the exciting new field of radiology
and published an important paper in 1910, Traumatic Malacia of the Lunate and its
Consequences, which described avascular necrosis of the lunate. Over 100 years later, the
condition, known as Kienbock disease, is still not fully understood. None-the-less, we wish him
Happy Birthday on January 11.
Best wishes,
Roy A. Meals, MD
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