Get access

Interventions for treating mallet finger injuries

  • Review
  • Intervention

Authors


Abstract

Background

Mallet finger, also called drop or baseball finger, is where the end of a finger cannot be actively straightened out due to injury of the extensor tendon mechanism. Treatment commonly involves splintage of the finger for six or more weeks. Less frequently, surgical fixation is used to correct the deformity.

Objectives

To examine the evidence for the relative effectiveness of different methods of treating mallet finger injuries.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to March week 1 2008), EMBASE (1988 to 2008 week 11), other databases, reference lists of articles and various conference proceedings.

Selection criteria

Randomised or quasi-randomised clinical trials evaluating different interventions, including no intervention, for treating mallet finger injuries.

Data collection and analysis

Both authors independently performed study selection, quality assessment and data extraction. Study authors were contacted for additional information.

Main results

Four trials were included. These involved a total of 278, mainly adult, participants with 283 mallet finger injuries. All four trials were methodologically flawed, including inadequate outcome assessment.

Three trials compared different types of finger splints versus a standard Stack splint. One trial found a lower incidence of treatment failure in participants treated with a perforated custom-made splint. One trial found there were fewer complications in participants treated with a padded aluminium-alloy malleable finger splint; however, the incidence of treatment failure was similar in the two treatment groups. One trial evaluating the Abouna splint found a similar incidence of treatment failure in the two groups. However, the Abouna splint often needed replacing due to disintegration of its rubber cover and rusting of the exposed wires and was also less popular with participants.

The fourth trial found no statistically significant differences between participants whose mallet finger was treated with Kirschner wire fixation and those with a Pryor and Howard splint. Similar numbers had complications in the two groups.

Authors' conclusions

There was insufficient evidence from comparisons tested within randomised controlled trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury. There was a useful reminder that splints used for prolonged immobilisation should be robust enough for everyday use, and of the central importance of patient adherence to instructions for splint use. There was insufficient evidence to determine when surgery is indicated.

摘要

背景

槌狀指的治療

槌狀指,或稱下降或棒球指,指的是手指末端因伸側肌腱受損導致伸直不能。常見的治療方式為小夾板固定治療6週或更久。少數情形需手術治療。

目標

檢視槌狀指的不同治療效果比較

搜尋策略

我們檢索了Cochrane Bone, Joint and Muscle Trauma Group Specialised Register(2005年6月),the Cochrane Central Register of Controlled Trials (The Cochrane Library 第2期,2005),MEDLINE(1966年至2005年6月第一週),EMBASE(1988至2005年第24週),其他數據庫,參考文獻目錄和各種會議記錄。

選擇標準

隨機或半隨機臨床試驗評估槌狀指的不同處置,包括不做任何處置。

資料收集與分析

兩位作者獨立完成的研究篩選,品質評估和數據提取。聯繫研究作者以獲得更多訊息。

主要結論

4個試驗被納入。總共278個患者,主要是成人,總計283隻槌狀指。四個試驗各有方法論上的存在缺陷,包括缺乏比較不適當的結果評估。三個試驗比較不同類型手指副木與標準Stack副木的療效。其中一個試驗發現使用客製化副木有較低的失敗率。另一個試驗發現使用墊鋁合金可塑性手指副木併發症較少,然而,失敗率兩組治療組是相似的。最末個試驗發現Abouna副木與標準Stack副木失敗率相當,且前者往往需要更換,由於它橡膠蓋的解體和生鏽的外露電線,較不受參與者青睞。 第四個試驗發現用Kirschner wire固定或Pryor及Howard副木治療無統計上差異,且兩組併發症數相當。

作者結論

在隨機對照試驗比較測試中沒有足夠證據比較不同的,甚至是客製化或現成的手指副木治療槌狀指的效果。注意長期使用阻止活動的副木需夠堅固,且需遵守使用手指副木的指示。沒有充分的實證告知何時是適切的手術時機。

翻譯人

本摘要由臺灣大學附設醫院曾渥然翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的實證說明槌狀指的最佳處置。槌狀指,也稱為下降或棒球指,是手指末端因受傷而無法伸直。通常外表皮膚是完整的,而造成機制為手指肌腱撕裂或肌腱附著處的小骨折。治療常包括用副木固定手指末端至少6週或更久。更嚴重的傷害需要手術處理。本篇回溯調查發現,沒有足夠的實證表明何種方法治療槌狀指是最有效的。

Plain language summary

Interventions for treating mallet finger injuries

Mallet finger, also called drop or baseball finger, is where the end of a finger cannot be actively straightened out due to injury. Typically the skin remains intact, and the impairment results from a tear of a finger tendon or a small fracture where the tendon attaches to the bone. Treatment commonly involves immobilising the finger-end in a splint for six or more weeks. Surgery may be used for more severe injuries.

Four randomised trials were included in the review. These involved a total of 278, mainly adult, participants with 283 mallet finger injuries. The methods of all four trials were flawed leading to concerns about bias. There was no pooling of data.

Three trials compared different types of finger splints versus a standard Stack splint. One trial found less treatment failure in participants treated with a perforated custom-made splint. A second trial found there were fewer complications in participants treated with a padded aluminium-alloy malleable finger splint. However, the incidence of treatment failure was similar in the two treatment groups of this trial. The third trial evaluated the Abouna splint and found a similar incidence of treatment failure in the two groups. However, the Abouna splint often needed replacing due to disintegration of its rubber cover and rusting of the exposed wires and was also less popular with participants.

The fourth trial in the review found no significant differences between participants whose mallet finger was treated with Kirschner wire fixation and those with a Pryor and Howard splint. Similar numbers had complications in the two groups.

The review concluded that there was not enough evidence to show which is the best way to treat mallet finger injury. It noted, however, that splints used for prolonged immobilisation should be robust enough for everyday use.

Get access to the full text of this article

Ancillary