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The prognosis and speed of peripheral nerve recovery depend very much on the level of injury, severity of injury, the surgical intervention and the subsequent rehabilitative process. Many high level injuries may take years or months for the affected peripheral nerve to recover. Prolonged muscle imbalance causes joint contractures and over-stretching of denervated muscles. Without proper care, hand function recovery may be limited even the nerve regenerated afterwards.

During the nerve regeneration period, splinting is one of the most useful modality to minimise deformities, prevent joint contractures and substitute loss motor control. Proper splinting encourages early use of the injured hand in daily activities. There are different types of splinting design for median nerve palsy, ulnar nerve palsy and radial nerve palsy. Dynamic splinting techniques are frequently employed to allow early prehension activities. Other therapeutic techniques, including pressure garment and sensory re-education are useful to enhance better functional return after nerve repair.

Background: The vast majority of acute closed tendinous mallet injuries are treated with a splint. Very few studies have directly compared splinting versus pinning the distal interphalangeal joint for this injury. The aim of this cohort study is to determine the outcomes of both methods.

Methods: A total of 59 patients with acute tendinous mallet injury were retrospectively enrolled (29 patients in conservative treatment and 30 patients in surgical treatment). Conservative treatment was performed using custom-made thermoplastic splint and surgical treatment was conducted with oblique K-wire fixation of the distal interphalangeal (DIP) joint. The DIP joint was immobilized for eight weeks in both treatments. Active ranges of motion of the affected finger and Miller’s classification were evaluated postoperatively.

Results: The mean extension lag of the DIP joint in the surgical treatment group was significantly better than it was with conservative treatment (2.1° vs 13.8°). Three patients who were noncompliant with the splint showed poor results, while no patients in the surgical treatment group had a poor result.

Conclusions: Surgical treatment with K-wire fixation leads to satisfactory results for acute tendinous mallet injury.

The terminology in describing splint or orthosis has been reviewed but there is no one single system adopted universally. Joint efforts by doctors, therapists and orthotists had been set up to review the classification of splint. Four ways of classifying hand splints have been introduced: namely, eponym, acronym, descriptive classification system and the classification system proposed by the American Society of Hand Therapists. These systems include the use of rote memory or logical deduction in grouping of splints. This paper describes the advantages and disadvantages of each classification system. Neither one of the systems stands out to be the best. A combination of the advantages of different systems, such as precision and logical deduction, may be an option for developing a new system. Moreover, communication, documentation and other environmental factors should also be considered.

We used calibrated 2D images uploaded by patients to an online platform to generate a 3D digital model of the limb. This was used to 3D print a splint. This method of 3D printing of splints was used for two patients who were not able to visit the hospital in person due to restrictions placed by the COVID-19 pandemic. Both patients were satisfied with the splint. We feel that this technology could be used to offer additional options to conventional splinting that allows contactless splint fitting.

Level of Evidence: Level V (Therapeutic)

The best treatment for mallet fingers is still a matter of debate. Numerous splints with different designs to keep the distal interphalangeal (DIP) joint in extension have been described in literature. The outcomes of splint treatment are generally good with occasional reports of minor skin complications. Percutaneous Kirschner-wire pinning of the DIP joint for closed tendinous mallet finger represents a alternative treatment modality that reliably immobilises the joint and does not need much patient compliance or use of an external splint. We report a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger.

Level of Evidence: Level V (Therapeutic)