Conservative versus surgical treatment of mallet finger: a pooled quantitative literature evaluation.

BACKGROUND Although common, mallet finger represents a spectrum of injuries for which there are many questions about the best form of treatment. A long-standing controversy continues as to strategies and techniques of treatment. This quantitative literature analysis is the first that makes use of an evidence-based evaluation process to pool across studies the outcomes of conservative versus surgical treatment of closed mallet finger injuries of both acute and chronic or recurrent types. METHODS Published articles in English were sought using multiple methods, including the MEDLINE and EMBASE databases, reference review, and correspondence with selected experts. Both observational and randomized trials were included. Results were summarized in terms of 95 percent confidence intervals, and sensitivity analysis was performed for two other amounts of residual extensor lag. RESULTS Of the 41 reports retrieved, 26 met inclusion criteria, including 21 for initial acute treatment (1146 pooled digits) and 5 for chronic or recurrent treatment (148 pooled digits). Successful outcomes were found in about 77 percent of mallet fingers treated conservatively by splintage, including 480 patients who were observed for a 2-year period. Patient satisfaction with conservative treatment was found to be about 83 percent in 6 studies recording overall patient satisfaction (315 pooled patients). Successful outcomes of surgical treatment for acute mallet finger averaged about 85 percent in 3 studies (60 pooled digits) and about 73 percent in 5 studies of chronic or recurrent mallet finger. CONCLUSIONS Conservative treatment of at least 80 percent of mallet finger injuries is safe, effective, well accepted by patients, and cost efficient compared with surgical treatment. Multiple types of surgical procedures are available when surgery is indicated for a limited number of open or otherwise complex mallet finger injuries as well as for chronic or recurrent mallet finger.