The use of Stack splint or aluminum finger splint in the conservative management of acute Doyle type IVb bony mallet finger

The aim of this study was to compare the functional outcomes and direct costs of Stack splints and aluminum finger splints when used in the conservative management of patients with acute Doyle type IVb bony mallet finger. We retrospectively analyzed demographic and clinical characteristics, functional outcomes (using the Crawford classification, DIP flexion angles, and extension lag measurements), time to confirmation of union, and splint costs of 24 patients treated with aluminum finger splints (Group 1) and 20 patients treated with Stack splints (Group 2). Of 44 patients, the median age was 38 (range, 20–59) years, 14 (32%) were smokers, 23 (52%) had fourth digit injuries, 32 (70%) had injuries to the dominant hand, 30 (68%) had a mechanism of injury of a fall, and median follow-up was 15 (range, 12–18) months; none of these differed significantly between Group 1 and Group 2 (all p > 0.05). In Group 1, functional outcomes were excellent and good in 14 (58%) and 10 (42%) patients, respectively; in Group 2 functional outcomes were excellent and good in 13 (62%) and 7 (35%) patients, respectively; and there was no significant difference between the groups. Median extension lag was 3.2° (range, 3.0°–3.5°) in group 1 and 3.4° (range, 3.2°–3.8°) in group 2, indicating no significant difference between groups. Complete union was confirmed radiographically in all patients. Per-patient cost was significantly lower for aluminum finger splints (0.208 TRY [US $0.03]) than for Stack splints (25 TRY [US $3.60]). Good functional outcomes are possible with the use of either Stack or aluminum finger splints in patients with acute Doyle type IVb mallet finger, confirming that conservative management may be appropriate for these injuries. Direct costs of Stack splints are many times greater than those of aluminum splints, though the costs for both are relatively low. Therapeutic, Level III.