The Journal of Hand Surgery - European Volume - April 2018 - 2

Journal of Hand Surgery (Eur) 43(Supplement 1)

outcomes. However, from a patients' perspective, the
type of technique does not affect the final degree of
satisfaction nor the opinion on scar appearance. This
is valuable information when skin grafts are
inevitable.

The Non-Surgical Management of Bony Mallet
Injuries

A Randomised Feasibility Trial Comparing Needle
Fasciotomy (NF) with Limited Fasciectomy (LF) for
Dupuytren's Contractures

Aims: There is no consensus on the optimal management for bony mallet injuries. Large fragments or a
subluxated joint may be indications for surgery.
However surgery has not been proven to be superior
to splinting and is associated with more serious complications. This paper reviews the non-surgical management of these injuries.
Methods: Over a 4 year period 220 mallet fractures in
213 patients were treated using a custom made
thermoplastic splint. Fractures were classified
according to the Wehbe
´ and Schneider classification.
Clinical results were collected prospectively, including VASpain, active range of motion and extensor lag.
All patients were later invited to complete a Patient
Evaluation Measure (PEM).
Results: There were 132 males and 81 females with a
mean age of 42 years (Range 12-93).
Mean splinting duration was 6.8 weeks. Joints
were congruent in 160 and subluxated in 58. There
were 2 physeal injuries. Less than 1/3 of the articular
surface was involved in 94, 1/3 to 2/3 in 100 and over
2/3 in 26 fingers.
At discharge from hand therapy (mean 85 days)
mean distal interphalangeal joint active range of
motion was 2 to 75 . Overall42 patients had a measurable extension deficit; the mean lag in this group
was 10 .
The mean PEM percentage was 22% at a mean of
1.75 years.
Comparing subluxated and congruent joints there
were no statistically significant differences in active
range of movement or PEM score. There was no significant differences in active range of movement or
PEM score depending on the fragment size or the
individual Wehbe
´ and Schneider classification.
Conclusions: Conservative treatment in this large
cohort demonstrates good outcomes. Splinting is
adequate treatment for bony mallet injury regardless
of size or subluxation.

Professor Timothy R C Davis, on behalf of the HAND-1
study investigators
Nottingham University Hospitals
Time in programme: Thursday 3rd May 09:19

Aim: To assess the feasibility of a multicentre randomised trial comparing Needle Fasciotomy (NF) with
Limited Fasciectomy (LF)for Dupuytren's contractures (DC).
Methods: A randomised feasibility trial of DC patients
aged !18 recruited at three clinics in England.
Participants were randomised to either NF or LF
treatment. Follow-up was at 2, 6 and 26 weeks post
surgery. Outcomes were numbers of patients
screened, eligible, randomised and followed up,
treatment adherence, and identification of a primary
outcome Patient Reported Outcome Measure (PROM)
for a future trial.
Results: Of 267 patients screened, 153 were eligible
and 71 randomised (46%). The commonest reason for
ineligibility was previous DC surgery to the same
hand (n ¼ 48). 75 eligible patients (49%) were not randomised due to treatment preference. Four participants did not receive their randomised treatment.
Median time to treatment was 97 (LF) and 41 (NF)
days. Follow-up at 26 weeks was 85%. Participants
felt that the MYMOP and PEM PROMS allowed them
to better describe the condition of their hands at each
of the three post-surgery follow-up timesthan the
DASH or URAM.
Conclusions: This study demonstrates that a definitive RCT is feasible. Broadening the inclusion criteria
could increase the number of potentially eligible
patients, and follow up duration should take surgery
waiting time into account. The MYMOP or PEM appear
the most suitable for use as the primary outcome.
Trial Registration: ISRCTN11164292
Funding: NIHR RfPB (PB-PG-0613-31083). The views
expressed are those of the author(s) and not necessarily those of the NHS, NIHR or Department of
Health.

Mr Ryan William Trickett, Mr James Brock and
Mr David Shewring
University Hospital of Wales
Time in programme: Thursday 3rd May 2018 09:26

Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018