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Silvio Tocco, B.Sc. in Occ. Th. & Biology
Occupational Therapist, Hand Therapy Specialist
Studio Terapico Kaiser (Parma) www.studiokaiser.com
Honorary Secretary for the Council of OT in the European Comunity (C.O.T.E.C.) www.cotec-europe.org
Member of the Italian OT Associazione council (A.I.T.O.) www.aito.it
Affiliated Professor and Clinical Placement Coordinator for Modena and Reggio-Emilia University
Effectiveness of Cast Immobilisation of Closed Mallet Finger Injuries: A Prospective Randomized Comparison with Thermoplastic Splinting.
Tocco, S., Boccolari, P., Landi, A., Leonelli, C., Mercanti, C., Sartini, S. and Zingarello, L.
Introduction: Splint models and wearing schedules vary greatly in the treatment of the mallet finger. One common denominator is the necessity to clean the finger regularly to prevent skin ulceration beneath the splint.
Objective: Evaluate the effectiveness of full-time immobilization (Group B= Quickcast® finishing tape) in the treatment of Type 1 mallet fingers in comparison to the traditional custom-made lever-type thermoplastic splint (Group A).
Methods: RCT, 57 digits, Immobilization periods of 6 or 8 weeks (acute/chronic), followed by 2 weeks of home-based exercises and intermittent splinting and 2 weeks of night wear. Groups similar at baseline (age, sex, time from injury, bony fragment, acuteness of injury). Pain, splint discomfort and easthetic appreciation, ADL/work/leisure performance, perceived rehabilitation difficulty and satisfaction assessed with VAS. Edema, AROM/PROM, grip/pinch strength, treatment complications and success rate were assessed through a blind-evaluation.
Results: No difference for all outcome measures except for: 1-Splint aesthetics in favour of Group B (A=3,43/B=1,92;p=0,04); 2- DIPj extension gains better in Group B (A=21,3°/B=27,2°;p=0,03); 3-Success rate (Abouna & Brown scale) higher for B (75%) than for A (53%).
Conclusion: According to this study, full-time immobilization of Type 1 mallet fingers was more effective than the traditional approach of instructing the patient on home-based splint removal for skin hygiene.