Splinting Alone is Effective for a Wide Range of Pediatric Mallet Finger Injuries

Columbus, OH – July 2018

While splinting has long been the most common treatment for pediatric mallet finger, there is little research investigating outcomes for this non-surgical approach.

A recent study from the Department of Orthopaedics at Nationwide Children’s Hospital suggests that the great majority of children with mallet finger injuries – even those with significant bony fracture fragments – return to normal activity with no residual extensor lag after splinting alone.

The study is published in The Journal of Hand Surgery.

“Anecdotally, we knew that we were treating most of these injuries conservatively, but we had never formally evaluated our outcomes,” says Julie Samora, MD, PhD, director of Orthopedic Quality Improvement and a pediatric orthopedic hand surgeon at Nationwide Children’s and senior author of the study. “It was fantastic to demonstrate that children do quite well with dedicated splint wear alone.  It is also helpful to know that there are good, but not as reliably good, outcomes when patients present a long time after the injury occurred. This information will help guide treatment discussions and manage patient and family expectations.”

Between 2013 and 2017, 94 patients with mallet finger with a mean age of 13.7 years were evaluated and treated at Nationwide Children’s. A total of 66 were boys and 28 were girls, and most injuries occurred during recreational activities.

One patient had surgery. The other 93 patients were treated with simple splints, including off-the-shelf “Stack” orthoses, modified aluminum orthoses and custom therapist-made thermoplastic orthoses.  .

Among the study’s findings:

  • 86 percent of patients had no residual extensor lag after splinting
  • In patients who presented immediately after injury, complications were rare
  • Lag and complication rate for patients presenting late after injury was higher (25% and 19%, respectively)
  • Treatment adherence was associated with better clinical outcomes, with nonadherent patients more likely to experience a residual extensor lag (11% vs. 67%) and potentially clinically relevant complications (8% vs. 50%).

Dr. Samora adds, “Any time we can avoid surgery in our pediatric patients, it is a win-win situation. From our findings, we recommend nonsurgical treatment with a strong adherence of splint wear for pediatric patients with mallet fingers.”


Lin JS, Samora JB. Outcomes of splinting in pediatric mallet finger. The Journal of Hand Surgery. 2018 May 15. [Epub ahead of print]