A single K-wire to prevent poor outcomes in closed soft-tissue mallet finger management due to patient non-compliance



Soft-tissue mallet finger occurs due to loss of terminal extensor tendon secondary to rupture of distal phalanx. Although using noninvasive splints for 6–8 weeks is the gold standard for conservative treatment of closed soft-tissue mallet injuries, patient compliance is an important factor impacting on patient outcomes. In this study, we used a single Kirschner Wire (K-W) to fix the distal interphalangeal (DIP) joint in extension in those patients failed to comply with routine splinting.

Materials and methods

In this prospective study, 190 patients with Doyle type 1 closed soft-tissue mallet finger deformity were included in four groups between 2011 and 2015. These groups were determined according to treatment modalities. Patients in the first group were treated with a finger splint (n = 109). Patients in the second group first received a finger splint and then K-W was applied due to lack of adequate compliance (n = 23). Patients in the third group were treated with K-W only (n = 47), and the fourth group did not accept surgical treatment nor conservative treatment (n = 11). After 20 weeks of follow up, we evaluated the results with functional measurements according to Crawford criteria and patient satisfaction. Additionally, the mid-term outcome was assessed with a follow-up at 2 years.


At 20th week postoperatively, average DIP extension lag was 6 degrees (0–30) for the first group, 6.1 degrees (0–30) for the second group, 3.8 degrees (0–25) for the third group, and 17.3 degrees (7–30) for the fourth group. Total patient satisfaction was 85%, which was considered excellent or good. Swan neck deformity was observed in 11% of patients. Osteomyelitis and KW related complications were not observed. There were no statistically significant differences between short-term and mid-term results.


Internal fixation via K-W may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients. Using this treatment approach, the success rate for patients could satisfactorily be improved.

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  1. 1.

    Valdes K, Naughton N, Algar L (2015) Conservative treatment of mallet finger: a systematic review. J Hand Ther 28:237–245

    Article  Google Scholar 

  2. 2.

    Altan E, Alp NB, Baser R et al (2014) Soft-tissue mallet injuries: a comparison of early and delayed treatment. J Hand Surg Am 39:1982–1985

    Article  Google Scholar 

  3. 3.

    Vernet P, Igeta Y, Facca S, Toader H, Hidalgo Diaz JJ, Liverneaux P (2019) Treatment of tendinous mallet fingers using a Stack splint versus a dorsal glued splint. Eur J Orthop Surg Traumatol 29(3):591–596

    Article  Google Scholar 

  4. 4.

    Alla SR, Deal ND, Dempsey IJ (2014) Current concepts: mallet finger. Hand [N Y] 9:138–144

    Article  Google Scholar 

  5. 5.

    Groth GN, Wilder DM, Young VL (1994) The impact of compliance on the rehabilitation of patients with mallet finger injuries. J Hand Ther 7:21–24

    CAS  Article  Google Scholar 

  6. 6.

    Lin JS, Samora JB (2018) Surgical and nonsurgical management of mallet finger: a systematic review. J Hand Surg Am. 43(2):146-163.e2

    Article  Google Scholar 

  7. 7.

    Crawford GP (1984) The molded polythene splint for mallet finger deformities. J Hand Surg Am 9(2):231–237

    CAS  Article  Google Scholar 

  8. 8.

    Schweitzer TP, Rayan GM (2004) The terminal tendon of the digital extensor mechanism: part II. Kinematic study. J Hand Surg Am 29:903–908a

    Article  Google Scholar 

  9. 9.

    O’Brien LJ, Bailey MJ (2011) Single blind, prospective, randomized controlled trial comparing dorsal aluminum and custom thermoplastic splints to stack splint for acute mallet finger. Arch Phys Med Rehabil 92:191–198

    Article  Google Scholar 

  10. 10.

    Auchincloss JM (1982) Mallet-finger injuries: a prospective, controlled trial of internal and external splintage. Hand 14:168–173

    CAS  Article  Google Scholar 

  11. 11.

    Simonian M, Dan M, Graan D et al (2018) Suture and splint compared with K-wire fixation for open zone 1 extensor tendon injuries. Ann Plast Surg 81:176–177

    CAS  Article  Google Scholar 

  12. 12.

    Cook S, Nikki D, Sarah W (2017) How do hand therapists conservatively manage acute, closed mallet finger? A survey of members of the British Association of Hand Therapists. Hand Ther 22:13–25

    Article  Google Scholar 

  13. 13.

    Facca S, Nonnenmacher J, Liverneaux P (2007) Treatment of mallet finger with dorsal nail glued splint: retrospective analysis of 270 cases. Rev Chir Orthop Reparatrice Appar Mot 93(7):682–689

    CAS  Article  Google Scholar 

  14. 14.

    Renfree KJ, Odgers RA, Ivy CC (2016) Comparison of extension orthosis versus percutaneous pinning of the distal interphalangeal joint for closed mallet injuries. Ann Plast Surg. 76(5):499–503

    CAS  Article  Google Scholar 

  15. 15.

    McKeon KE, Lee DH (2015) Posttraumatic Boutonnière and swan neck deformities. J Am Acad Orthop Surg 23(10):623–632

    Article  Google Scholar 

  16. 16.

    Tocco S, Boccolari P, Landi A et al (2013) Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: a randomized clinical trial. J Hand Ther 26(3):191–200

    Article  Google Scholar 

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Correspondence to Tolga Aksan.

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Aksan, T., Öztürk, M.B. & Özçelik, B. A single K-wire to prevent poor outcomes in closed soft-tissue mallet finger management due to patient non-compliance. Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-021-03793-4

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  • Mallet finger
  • Compliance
  • Extensor tendon
  • Finger deformity