search
Back to results

Comparison of Splinting Interventions for Treating Mallet Finger Injuries

Primary Purpose

Mallet Finger

Status
Unknown status
Phase
Not Applicable
Locations
Australia
Study Type
Interventional
Intervention
Circumferential thermoplastic thimble splint
dorsal aluminium foam "Mexican Hat" splint
stack splint (control)
Sponsored by
Bayside Health
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mallet Finger focused on measuring distal, interphalangeal, extensor tendon, avulsion

Eligibility Criteria

16 Years - 80 Years (Child, Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: - All referrals of patients with mallet finger injuries will be considered for inclusion with the exception of the following exclusion criteria. Exclusion Criteria: open injuries mallet injury to thumb co-existing rheumatologic illness time from injury to presentation greater than 2 weeks

Sites / Locations

  • The Alfred Hospital

Outcomes

Primary Outcome Measures

Degree of extensor lag at distal inter-phalangeal (DIP)joint

Secondary Outcome Measures

Active range of motion at DIP
Patient compliance with splinting regime, based on self-report (as described above)
Patient satisfaction with result on 5-point likert scale
Complications
Pain, measured by 10 point Visual Analogue Scale

Full Information

First Posted
April 2, 2006
Last Updated
April 2, 2006
Sponsor
Bayside Health
search

1. Study Identification

Unique Protocol Identification Number
NCT00310570
Brief Title
Comparison of Splinting Interventions for Treating Mallet Finger Injuries
Official Title
Comparison of Splinting Interventions for Minimising Extensor Lag in Mallet Finger Injuries
Study Type
Interventional

2. Study Status

Record Verification Date
April 2006
Overall Recruitment Status
Unknown status
Study Start Date
May 2006 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
September 2007 (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
Bayside Health

4. Oversight

5. Study Description

Brief Summary
Stubbing of the finger-tip is a common injury in sports such as basketball, volleyball, cricket and football. This can result in a Mallet finger deformity, where the end joint of a finger cannot be actively straightened out. In most mallet finger cases seen at The Alfred, the skin remains intact, and the impairment results from a tear of the extensor tendon or an avulsion (a small fracture where the tendon attaches to the bone). Treatment commonly involves immobilising the end joint of the finger in a splint for six or more weeks so patient compliance is a major factor in the quality of the outcome achieved. This study aims to compare two different types of splintage (the commonly used thermoplastic thimble splint and the aluminium-foam "Mexican hat" splint which is in use in Britain) with a control splint (thermoplastic prefabricated "stack splint" with tape). Outcome measures will include patient compliance with the splint, degree of extensor lag, active movement of the joint, and any complications. The null hypothesis is that there are no differences in outcome between different methods of conservative splinting treatment for mallet finger.
Detailed Description
Literature Review: Mallet finger is defined as a loss of continuity of the distal insertion of the extensor tendon at the finger tip. It is a common hand injury in ball sports (McCue and Garroway 1985) but can also occur from minor incidents such as bed-making and trips/falls (Abouna and Brown, 1968). The injury results in a drooping of the distal inter-phalangeal joint, and is usually managed conservatively by splinting in hyper-extension for 6 or more weeks. This position allows relaxation of the tendon and encourages healing by bringing the torn ends or fracture fragments closer together during the healing phase. A recent Cochrane Systematic review of the evidence in treating this injury (Handoll and Vaghela, 2005) found that there is insufficient evidence in existing randomised controlled trials to establish the effectiveness of different (either custom-made or off-the-shelf) finger splints for treating mallet finger injury. They commented that there were only 4 trials that met the inclusion criteria, and all of these were "small, heterogeneous, inadequately described and reported….and had methodological flaws". Evidence provided is therefore an inadequate base for clinical decision making. Rationale for project: If mallet injuries are not managed correctly, the patient can be left with a persistent extension lag (loss of voluntary straightening) and swan neck deformity (severe flexion deformity of distal finger joint plus a secondary hyperextension deformity of the proximal joint resulting from an imbalance in the extensor mechanism). Mallet injuries are relatively common, with an estimated 100 cases treated at the Alfred last year, and there is some debate about the best approach for their management. The plastic surgery unit is keen to determine the optimal treatment for these injuries. The Cochrane systematic review (Handoll and Vaghela, 2005) found that there were only four relevant trials that met inclusion criteria, and all of these had methodological flaws. As this is a commonly presenting injury at The Alfred, an opportunity exists to add to the evidence base by conducting a well-designed and thorough trial comparing the two most commonly advocated treatments with a suitable control. Hypothesis/research questions: Null Hypothesis: There are no differences in outcome between different methods of conservative splinting treatment for mallet finger. Aims: To determine the most appropriate conservative treatment for mallet finger injuries. Methodology: We aim to conduct a randomised controlled trial of over 100 participants, based on current referrals to hand therapy. Subjects will be allocated to one of the following groups using a randomised computer sequence: Circumferential thermoplastic thimble splint, or dorsally applied aluminium-foam "Mexican hat" splint, or control splint (off-the-shelf thermoplastic "stack" splint with tape). NB it was considered unethical to provide a "no treatment" control given the amount of extension loss expected in an untreated injury and the likelihood of persistent finger deformity. All other aspects of treatment including frequency of contact, duration of initial period of splintage, and patient advice (eg hygiene routine, exercise, splint donning/doffing) will remain the same across all groups. Baseline data: age gender hand dominance time since injury type of injury (bony versus soft-tissue) degree of extensor lag (measured with a standardised goniometer) presence of other hand injuries on injured hand smoker/non-smoker medication hand dominance occupation or hobbies Progressive measurements (to be taken at 6, 8, 10, 12, and 20 weeks): degree of extensor lag (measured with a standardised goniometer) development of complications, and whether a change in splint type was required patient adherence to treatment protocol, based on self-report. Patients will be provided with a simple diary to complete which records incidences of removal or adjustment of splint, the reason(s) for this (eg skin breakdown, poor splint fit, dislodged during activity), and time out of splint Outcome measures (to be taken at 10, 12 and 20 weeks): degree of extensor lag at the DIP active range of motion at DIP patient satisfaction with result on 5-point likert scale pain, measured by 10 point Visual Analogue Scale Blinding of assessors: - all progressive and outcome measurements will be taken by a separate assessor (not one of the current treating hand therapists) trained in taking the measurements who has been blinded to the type of splint used. To ensure this, splints will be removed prior to the assessment and re-applied afterwards by the Allied Health Assistant using a standard donning/doffing technique. Inclusion/exclusion criteria: All referrals of patients with mallet finger injuries will be considered for inclusion with the exception of the following exclusion criteria: open injuries (where skin has been breached) mallet injury to thumb co-existing rheumatologic illness time from injury to presentation greater than 2 weeks Randomisation procedures: Participants will be randomised to either of the 3 groups using a computer-generated randomised sequence. Statistical or other analyses: Sample size: We are aiming for 100 subjects, but if referrals are low, we have calculated statistical power for a total of 75 subjects: - With 25 subjects per group this study will have an 80% power to detect a difference in continuous variables equivalent to 80% of a standard deviation with a 2-sided p-value of 0.05. Based on the assumption of normality, a reduction of one standard deviation would be equivalent to about 24%, therefore a reduction of .8 of a standard deviation would be approximately equivalent to a 20% reduction. A difference of this size is perceived to be of clinical importance. Repeat measures analysis will further increase the power of this study although until between measures variability can be assessed, it is unsure by how much. All data will be analysed using SAS version 8.2 (SAS Institute Cary, NC, USA). Data will be assessed for normality and log-transformed where appropriate. Univariate analysis will be conducted using chi-square test for equal proportion, analysis of variance and non-parametric Kruskal wallis tests where required. Multivariate analysis will be performed using generalised linear modelling adjusting for potential covariates and repeat measures. A two sided p-value of 0.05 will be considered to be statistically significant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mallet Finger
Keywords
distal, interphalangeal, extensor tendon, avulsion

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Single
Allocation
Randomized
Enrollment
100 (false)

8. Arms, Groups, and Interventions

Intervention Type
Device
Intervention Name(s)
Circumferential thermoplastic thimble splint
Intervention Type
Device
Intervention Name(s)
dorsal aluminium foam "Mexican Hat" splint
Intervention Type
Device
Intervention Name(s)
stack splint (control)
Primary Outcome Measure Information:
Title
Degree of extensor lag at distal inter-phalangeal (DIP)joint
Secondary Outcome Measure Information:
Title
Active range of motion at DIP
Title
Patient compliance with splinting regime, based on self-report (as described above)
Title
Patient satisfaction with result on 5-point likert scale
Title
Complications
Title
Pain, measured by 10 point Visual Analogue Scale

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: - All referrals of patients with mallet finger injuries will be considered for inclusion with the exception of the following exclusion criteria. Exclusion Criteria: open injuries mallet injury to thumb co-existing rheumatologic illness time from injury to presentation greater than 2 weeks
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Richard Bloom, MBBS, FRACS
Phone
+613 9276 2000
Email
R.Bloom@alfred.org.au
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lisa O'Brien, M.Clin.Sci
Organizational Affiliation
The Alfred
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Alfred Hospital
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3004
Country
Australia
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lisa O'Brien, M.Clin.Sci
Phone
+61 9276 3526
Email
L.Obrien@alfred.org.au
First Name & Middle Initial & Last Name & Degree
Ben Cunningham, B.Occ.Ther
Phone
+61 9276 3526
Email
B.Cunningham@alfred.org.au
First Name & Middle Initial & Last Name & Degree
Lisa O'Brien, M.Clin.Sci
First Name & Middle Initial & Last Name & Degree
Ben Cunningham, B.Occ Ther

12. IPD Sharing Statement

Citations:
PubMed Identifier
11560435
Citation
Wilson SW, Khoo CT. The Mexican hat splint--a new splint for the treatment of closed mallet finger. J Hand Surg Br. 2001 Oct;26(5):488-9. doi: 10.1054/jhsb.2001.0590.
Results Reference
background
PubMed Identifier
15266538
Citation
Handoll HH, Vaghela MV. Interventions for treating mallet finger injuries. Cochrane Database Syst Rev. 2004;(3):CD004574. doi: 10.1002/14651858.CD004574.pub2.
Results Reference
result
PubMed Identifier
21272714
Citation
O'Brien LJ, Bailey MJ. Single blind, prospective, randomized controlled trial comparing dorsal aluminum and custom thermoplastic splints to stack splint for acute mallet finger. Arch Phys Med Rehabil. 2011 Feb;92(2):191-8. doi: 10.1016/j.apmr.2010.10.035.
Results Reference
derived

Learn more about this trial

Comparison of Splinting Interventions for Treating Mallet Finger Injuries

We'll reach out to this number within 24 hrs