Non-Surgical Management of Boney Mallet Fractures: A Single-Centre Study of Outcomes in 141 Patients

Mallet fractures are traditionally treated surgically when greater than one third of the articular surface is involved. We aimed to investigate outcomes in a cohort of 141 patients with Doyle Type IV closed mallet injuries, treated with conservative splint therapy. Pearson chi-squared test was used to investigate the significance of subluxation and articular surface greater than one third. Articular surface was also investigated as a continuous variable using Spearman-rank correlation. Sixty-five patients had involvement of less than one third of the articular surface, and 75 had involvement of one third to two thirds. Subluxation was present in 53. Crawford outcomes were excellent in 54% of patients, good in 37%, and fair in 9%. Percentage of articular surface involvement and presence of subluxation were both independent of outcomes. Our findings support non-surgical treatment of closed mallet injuries in the presence of up to two thirds of articular surface involvement.