Background:

Mallet injury is a common injury managed conservatively by hand therapists, however previous literature including a 2004 Cochrane Review has not identified the optimal type of orthosis or duration of wear.

Aims:

To evaluate orthoses used in the management of zone 1 tendon mallet injury to: 1) Determine which orthosis has the least skin complications; 2) Determine which orthosis results in the least extensor lag; and 3) Determine which orthosis has the highest rates of treatment success according to Abouna and Brown Criteria

Method:

Design: Systematic Review and Meta-analysis

Five databases were searched for controlled trials meeting the inclusion criteria. The search yielded seven trials with 491 participants. The PEDro scale was used to assess methodological quality and the GRADE approach was used to assess risk of bias for each body of evidence.

Results:

Prefabricated orthoses had nearly 7 times the risk of skin complications when compared to custom thermoplastic orthoses (RR 6.72, 95% CI). Outcomes were similar for treatment success and extensor lag across splint types. Overall lag improved from a 32 degree mean to 5.7-13 degree range but lag increased between full time splint wear and 12 weeks. There was a treatment failure of 32%.

Conclusion:

Prefabricated orthoses were found to increase the risk of skin complications compared with custom orthoses but there were no differences in treatment success, failure or extensor lag. Given the risk of skin complications, vulnerable populations such as those with poor skin integrity should be managed with custom orthoses.