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A Prospective Randomized Controlled Trial of Night Splinting Versus No Splinting after Treatment of Mallet Finger
Jillian Gruber, BA; Arjan G.J. Bot, MD; David C. Ring, MD, PhD;
Massachusetts General Hospital

Introduction: In patients with a mallet finger, we tested the hypothesis that there is no difference in extensor lag between patients that night splint for an additional month after ceasing continuous splinting and patients that do not night splint. We also sought to determine whether night splinting was a predictor of patient-rated disability or treatment satisfaction.

Materials & Methods: We randomized 50 patients who underwent a period of continuous splinting for mallet finger to night splint for an additional month or to not night splint. At enrollment, patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Flexion and extension of the distal interphalangeal joint (DIP) and proximal interphalangeal joint (PIP) were measured for both the injured and contralateral uninjured finger. At the follow-up visit approximately 4 weeks later, the same measurements were repeated, and patients completed the DASH and ordinal scale for treatment satisfaction. Patients who did not return were contacted to complete the DASH and treatment satisfaction scale over the phone. The Chi-Square Test was used to determine differences in baseline values and outcome variables between cohorts. Bivariate and multivariable analyses were used to determine predictors of extensor lag, disability, and treatment satisfaction. Analysis was by intention to treat.

Results: There were no significant differences in mean extensor lag (p=0.32), disability (p=0.75), or treatment satisfaction (p=0.56) between patients that night splinted (n=24) and patients that did not (n=26). There was a significant correlation between final disability and satisfaction (r=-0.51, p<0.001), and a slight, but near significant correlation between final disability and lag (r=0.26, p=0.067). There were no significant predictors of disability or satisfaction. While age correlated significantly with extensor lag (p=0.005), the best linear regression model included initial lag and follow-up DIP flexion and accounted for 25% of the variation in final lag. 28% of patients (14/50) had a lag of 20 degrees or greater. There were no significant differences between bony and tendinous mallets.

Conclusion: Night splinting does not reduce lag or disability and does not increase treatment satisfaction.

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