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American Association for Hand Surgery

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Factors associated with patient dissatisfaction after surgery for bony mallet fingers
Roh Young Hak, MD, PhD, Ewha Womans University Medical Center, Seoul, Korea, Republic of (South) and Kim Sumin, MD, Ewha Womnas University Medical Center, Seoul, Korea, Republic of (South)

The aim of this study was to analyze the factors that affect patient satisfaction following surgery for bony mallet fingers.
A total of 74 patients who had been diagnosed with bony mallet fingers and treated surgically with extension block pinning were enrolled. The degree of extensor lag at the distal interphalangeal joint, Disability of the Arm, Shoulder, and Hand (DASH) score, and satisfaction with treatment were assessed at six-month follow-up. The patients' experienced role in surgical decision-making was also assessed using a Control Preference Scale (CPS). The factors that were assessed for their influence on treatment satisfaction were age, sex, occupation, hand dominance, involved finger, type of injury, time to surgery, CPS scores, final extension lag, and DASH scores.
At six months of follow-up, the mean extensor lag was 12.9 (range 0-30), the mean QuickDASH score was 16.4 (range 0-36), and the mean satisfaction score was 3.8 (range 2-5). Regarding satisfaction, 53 patients (71.6%) were satisfied while 21 (28.4%) were not satisfied. Compared to the satisfied group, the not-satisfied group showed significantly worse outcomes on the extension lag, but similar DASH scores. The patients in the not-satisfied group were younger and had higher CPS scores. There were significantly more female patients in the not-satisfied group. Multivariable regression analysis revealed that dissatisfaction after surgical treatment for bony mallet fingers was associated with female sex, higher CPS scores, and higher degree of extension lag, and these three factors accounted for 39 % of the variance in the treatment satisfaction.
Extension blocking pinning for bony mallet fingers leads to generally satisfactory results, but female patients, patients with a high degree of extension lag, and patients with passive involvement in surgical decision making are at risk for dissatisfaction with treatment, even when they have similar functional outcomes.

Table_Clinical differences between the satisfied and not-satisfied groups


Satisfied Group
(n = 53)

Group (n = 21)


Age (years)

39.9 ± 9.1

35.1 ± 8.9


Sex (male/female)

39 (74%) /14 (26%)

10 (48%) /11 (52%)


Manual labor

10 (19%)

7 (33%)


Dominant side

32 (60%)

15 (71%)


Involved fingers (2/3/4/5)




Sports-related injury

21 (40%)

7 (33%)


Time to surgery (weeks)

1.3 ± 1.7

1.6 ± 1.8


CPS scores
Extensor lag (degree)

2.7 ± 1.6
11.2 ± 4.9

3.7 ± 1.8
17.4 ± 5.3


QuickDASH scores

14.9 ± 13.0

20.1 ± 14.2


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