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Background: Stack splint is commonly used for mallet finger treatment but patients had a tendency to frequently remove it because of skin complications. We hypothesized that a comprehensively instructed splinting regime would increase patients’ compliance and lead to favorable outcomes with fewer skin complications. The aims of this study were to assess the patients’ compliance and to evaluate outcomes with that particular splinting regime. Methods: Forty-six consecutive patients were enrolled in this prospective study. They were instructed to wear the Stack splint for 24 hours a day every day in the first six weeks and remove it once a day for 10 minutes to vent. They were told to support distal interphalangeal joint volarly both while wearing the splint and when it was removed. Free movement of proximal interphalangeal joint within the splint was checked after each application. Following whole-day regime for 6 weeks, night splinting continued for 2 more weeks. Range of motion, skin complications, patients’ compliance and satisfaction were assessed at last follow-up. Results: There were 26 patients with a mean age of 39.8 and mean follow-up period of 6.7 months. No skin complications or proximal interphalangeal joint stiffness were reported. However, nine patients declared that they wore the splint ≤ 4 weeks, the compliance rate to our regime was 65.4% (17/26). In the 17 fully compliant patients, mean distal interphalangeal joint extension lag was 12.4 and nine of them (52.9%) were satisfied with the outcome. Conclusions: Our both hypotheses failed; comprehensive instructions for the splinting regime did not improve patients’ compliance satisfactorily, nor did it lead to favorable outcomes. Although Stack splint has practical points, we no longer use it.

Treatment of comminuted intra-articular fractures of the digits with the Pins and Rubbers Traction System (PRTS) has been reported in many small series to give good results. Our experience in more than 40 cases with this technique, however, has not always been favorable. We analyzed outcomes and complications of PRTS treatment in 25 patients with proximal interphalangeal joint fractures reviewed at a mean 13 months (range, 6-52 months) after surgery. Mean arc of motion at this joint was 67.2 degrees (range, 35-110 degrees ) and at the distal interphalangeal joint 40.7 degrees (range, 0-90 degrees ). The latter was immobile in 3 (12%) and 7 patients (28%) had superficial pin track infections. Loss of extension at both joints was a major factor in poor outcomes. Based on this experience, we suggest ways of avoiding common pitfalls of PRTS treatment. Concurrent internal fixation impacts significantly on interphalangeal joint stiffness.

Purpose The purpose of this study was to quantify the stiffness of the human finger proximal interphalangeal (PIP) joint and to study its relationship to different common clinical parameters. Methods Eighty-nine normal adult subjects had their PIP joints of the index, middle, and ring fingers evaluated using a computer-controlled moment-angle plotter. This device was used to measure stiffness and energy absorbed at the PIP joint during passive flexion and extension. Results The average overall stiffness was 0.05 N-cm/degree. There was a weak correlation between stiffness and energy absorbed and the size of the finger: they both increased with the size of the finger. The men's fingers were stiffer and absorbed more energy than the corresponding women's fingers. No significant associations were found between the time of day when the test took place, occupation, hobbies, or age with stiffness or absorbed energy. No significant differences were associated with hand dominance. The finger on the dominant hand had a larger circumference for both genders. Heavier individuals had more stiffness and absorbed more energy than lighter individuals. Conclusions The PIP joint stiffness was defined quantitatively and measured over a wide cross-section of a normal population. This may allow future studies to record the outcome of different treatments for finger joint stiffness objectively. The stiffness was greater in men and in larger fingers.

Conventional immobilisation following surgery for claw hand reconstruction necessitates altogether more than six weeks of post-operative physiotherapy. Two to four weeks of physiotherapy was required for re-education of the transferred tendons and an additional period of physiotherapy was needed to overcome the interphalangeal joint stiffness seen in all hands—even those with no pre-operative I.P. stiffness. Fifty hands with no pre-operative I.P. stiffness were immobilised post-operatively following claw hand correction by three different techniques, (Conventional technique 20 hands; Modification type 1, 10 hands and Modification type 2, 20 hands). Modification type 1 produced unsatisfactory results. Modification type 2 however, resulted in near total absence of I.P. stiffness with no additional physiotherapy required to overcome the minimal stiffness, without interfering with the results of reconstructive surgery. Type 2 immobilisation was achieved by a volar plaster slab extending from just below the elbow to the finger tips with circumferential plaster up to just beyond the metacarpophalangeal joints. Modification type 2 is recommended.