Study Summary

48 patients with acute closed tendinous mallet finger were randomized to receive either Kirschner wire (K-wire) fixation or thermoplastic splinting. 7 patients were lost to follow-up, leaving 41 patients analyzed. The primary outcomes of interest were distal interphalangeal (DIP) joint extension and flexion angles, extension lag, and functional grading using the Abouna-Brown and Crawford criteria. Secondary outcomes included correlations between baseline and fixation variables with final extension, complication rates, and the effect of active rehabilitation exercises on extension recovery. Outcomes were assessed at 1 week, 8 weeks, and 16 weeks. Overall, the results of the study revealed no significant differences between K-wire fixation and thermoplastic splinting in final DIP joint extension, extension lag, or functional grading at 16 weeks. Both groups demonstrated an early decline in extension after immobilization removal, followed by partial recovery with sustained active exercise. Complication patterns differed between groups but were generally minor and manageable. These findings suggest that both surgical and nonsurgical approaches are similarly effective, with active rehabilitation playing an important role in extension recovery.