Conservative management of mallet injuries: A national survey of current practice in the UK

Introduction Mallet injuries are common, and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding best management and it is unclear whether this uncertainty is reflected in current UK practice. Methods An online survey was developed to determine current practice for the conservative treatment of mallet injury amongst specialist hand clinicians in the UK, including physiotherapists, occupational therapists and surgeons. Clinician’s views of study outcome selection were also explored to improve future trials. Results 336 professionals completed the survey. Inconsistency in overall practice was observed in splint type choice, time to discharge to GP, and the assessment of adherence. Greater consistency was observed for recommended duration of continuous immobilisation. Bony injuries were most commonly splinted for six weeks (n=228, 78%) and soft tissue injuries for either eight weeks (n=172, 56%) or six weeks (n=119, 39%). Postimmobilisation splinting was frequently recommended, but duration varied between two and 10 weeks. The outcome rated as most important by all clinicians was patient satisfaction. Discussion There is overall variation in the current UK conservative management of mallet injuries, and the development of a standardised, evidence based protocol is required. Clinicians’ opinions may be used to develop a core set of outcome measures, which will improve standardisation and comparability of future trials.