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Splinting Versus Surgical Percutaneous Pinning for the Treatment of Soft Tissue Mallet Finger: A Retrospective Cohort Analysis
Gregory R Toci, BS1, Francis Sirch, BS1, David Lippe, BS1, Eric Tecce, BS1, Amr Tawfik, BA1, Brian M Katt, MD1, Daren Aita, MD2, Pedro K Beredjiklian, MD3 and Daniel Fletcher, MD2, (1)Rothman Orthopaedic Institute, Philadelphia, PA, (2)Rothman Institute, philadelphia, PA, (3)Rothman Institute, Philadelphia, PA

Mallet finger is a common injury involving disruption of the extensor tendon (categorized as soft tissue) or a bony fracture (categorized as bony) of the distal phalanx at the insertion of the extensor tendon, and up to two-thirds fall into the soft tissue category. Common surgical procedures include Kirschner (K) wire fixation or suture anchor fixation. Conservative options include splint immobilization for 6-8 weeks. The literature has shown that soft tissue injury has increased residual extensor lag than bony injury, but we could not identify comparative studies between surgical and non-surgical treatment in the soft tissue mallet finger population. The purpose of this study was to compare surgical versus non-surgical management of soft tissue mallet finger injury to determine if there are differences in residual extensor lag and complication rates.

Patients undergoing mallet finger management from 2011 to 2020 were identified using Current Procedural Terminology (CPT) code 26432. Exclusion criteria included patients less than 18 years of age, open mallet finger injury, bony mallet finger injury, and incomplete documentation of extensor lag at treatment follow-up. Complications, including infection, dislodged or broken hardware, and wound or skin complications, were collected from follow-up clinic notes. Complications were categorized as either minor or major, with major ones requiring revision surgery or intravenous antibiotics.

A total of 231 soft tissue mallet fingers met the inclusion and exclusion criteria. Of which, 195 were treated with splinting and 36 were treated with percutaneous surgical pinning. There were no significant differences between groups in the age (Splinting: 49.9, Pinning: 54.0, p=0.142), sex (Splinting: 30.3% female, Pinning: 38.9% female, p=0.308), body mass index (Splinting: 27.0, Pinning: 28.0, p=0.108), or laterality (Splinting: 52.3% right, Pinning: 55.6% right, p=0.721). There was no difference in extensor lag between groups (Splinting: 6.7 degrees, Pinning: 5.4 degrees, p=0.495). The pinning group had a higher overall complication rate than the splinting group (25.0% vs. 0.5%, p<0.001). The pinning group also had a higher complication rate of infection than the splinting group (11.1% vs. 0.5%, p<0.001)

Surgical pinning represents an effective form of treatment for soft tissue mallet injury, although the increased complication rate suggests increased risk. Surgical treatment for soft tissue mallet injury merits further investigation, and hand surgeons should not exclude a patient from surgical consideration based on soft tissue involvement alone.

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