Z Tolkien1, S Potter1, N Burr2, M D Gardiner3, J M Blazeby1, A Jain4, J Henderson5. 1. Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. 2. Royal Free Hospital London, Pond Street, London, NW3 2QG, UK. 3. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK; Department of Plastic Surgery, Imperial College, London, SW7 2AZ, UK. 4. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK; Department of Plastic Surgery, Imperial College, London, SW7 2AZ, UK. Electronic address: abhilash.jain@kennedy.ox.ac.uk. 5. Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Bristol, UK.
Abstract
INTRODUCTION: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is unclear whether this uncertainty is reflected in current UK practice. METHODS: An online survey was developed to determine the current practice for the conservative treatment of mallet injury among 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: In total, 336 professionals completed the survey. Inconsistency in overall practice was observed in splint type choice, time to discharge to GP, and assessment of adherence. Greater consistency was observed for recommended duration of continuous immobilisation. Bony injuries were most commonly splinted for 6 weeks (n = 228, 78%) and soft tissue injuries for either 8 weeks (n = 172, 56%) or 6 weeks (n = 119, 39%). Post-immobilisation splinting was frequently recommended, but duration varied between 2 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. Crown
INTRODUCTION:Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is unclear whether this uncertainty is reflected in current UK practice. METHODS: An online survey was developed to determine the current practice for the conservative treatment of mallet injury among 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: In total, 336 professionals completed the survey. Inconsistency in overall practice was observed in splint type choice, time to discharge to GP, and assessment of adherence. Greater consistency was observed for recommended duration of continuous immobilisation. Bony injuries were most commonly splinted for 6 weeks (n = 228, 78%) and soft tissue injuries for either 8 weeks (n = 172, 56%) or 6 weeks (n = 119, 39%). Post-immobilisation splinting was frequently recommended, but duration varied between 2 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. Crown