Thirty-two patients with bony mallet finger were randomized to receive 6 weeks of splinting or a extension block pinning procedure. The primary outcome of interest was active extension lag at the distal interphalangeal joint. Secondary outcomes of interest included finger-to-palm distance, active range of motion in flexion, joint range of motion, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) scores, pain on a numeric rating scale (NRS), and incidence of adverse events. All secondary outcomes were assessed at 6 months post-treatment. Results revealed that active range of motion in flexion, finger-to-palm distance, and joint range of motion were significantly in favour of the splinting group compared to the extension block pinning group at 6 months follow-up. In all remaining outcomes, no significant differences were observed between the two treatment arms.