Makeshift Mallet Splint – Neither Safe, Nor Effective

We read this article with some concern. It describes a novel technique of treating mallet finger injuries using disposable razor guards. It may be simple and inexpensive, but we believe it is neither safe, nor effective.

First, use of the single-size guard places pressure on the digit. In a field test, it caused discomfort, skin blanching and pinching of a petite young lady's finger (Fig. 1). This places the skin at high risk of lacerations and pressure necrosis,1 converting a closed zone ¹ extensor injury into an open zone 2 injury. Second, the part of the guard supporting the distal phalanx is angulated by approximately 5° causing corresponding flexion at the distal interphalangeal joint. This is contrary to the management aim of splinting this joint in extension for 6–8 weeks² and may lead to a poor outcome.

Figure 1.

Disposable razor guard showing tip congestion, skin blanching and pinching.

We encourage the use of ‘eco-friendly’ and inexpensive treatment options, but issues of safety and efficacy cannot be overlooked. Zimmer splints are inexpensive and are usually readily available, but the gold standard is a custom-made thermoplastic splint. We therefore advise against the use of these guards in treating mallet fingers.