Abstract
Purpose: The aim of the study was to compare and determine the effectiveness of conservative splint treatment and surgical extension block pinning treatment of mallet fractures containing more than one-third of the articular surface.
Methods: The study included 39 patients who were diagnosed with acute closed bony mallet finger of which the fracture line contained at least one-third of the articular surface, treated between January 2017 and January 2020. Of the patients, 23 (16 men and 7 women) were treated surgically with the extension block pinning method and 16 (12 men and 4 women) were treated with the hyperextension finger splint. Patients with a follow-up period of at least one year were evaluated. The patients were compared based on their Crawford mallet finger outcome assessment criteria, Michigan Hand Outcome Questionnaire scores and joint restriction limitations. Data were analyzed with the SPSS 21 package program. The significance level was p<0.05.
Results: The mean age in the conservative group 29.81 ± 9.89 (18-51) and the mean follow-up duration was 26.87 ± 9.53(12-38) months. The mean age in the EBP group was 36.83 ± 13.72 (18-64) years and the mean follow-up duration was 31.61 ± 9.05(14-41) months. According to the Crawford assessment criteria, the patients in the EBP group had the following outcomes: excellent in 7 patients (30.4%), good in 3 patients (13%), fair in 11 patients (8.7%), and poor in 2 patients (8.7%). In the conservative group, 4 (25%) patients had excellent outcome, 4 (25%) had good outcome, 6 (37.5%) had fair outcome and 2 (12.5%) had poor outcome. There was no significant difference between the groups in terms of MHOQ scores.
Conclusion: In conclusion, it was found that there are no differences between surgical and conservative treatments after bony mallet finger injuries in terms of functional outcomes but permanent complication and flexion limitation are more common after surgical treatment while active extension limitation is more common after the conservative treatment. According to this information, the individual treatment approach should be adapted considering the variables like the patient's age and profession.

Key words: mallet finger, extension block pinning, splinting