SCIENTIFIC ARTICLE Soft-Tissue Mallet Injuries: A Comparison of Early and Delayed Treatment Egemen Altan, MD, Nazmi Bulent Alp, MD, Reyhan Baser, MD, Levent Yalçın, MD Purpose To compare the results of early and delayed extension orthosis fabrication in closed tendinous mallet injuries. Methods Between March 1992 and May 2011, 45 patients with isolated closed tendinous mallet finger injuries were treated with orthosis fabrication. The patients were classified into 2 different groups based on their date of presentation. Group 1 consisted of 28 patients who presented within 2 weeks of sustaining the trauma, and group 2 consisted of 17 patients who received treatment beginning between 2 and 4 weeks after sustaining the trauma. During the final assessments, the patients were assessed clinically using the Crawford classification scale and satisfaction ratings. Results The mean delay between initial injury and presentation to our center was 3 days (range, 1e14 d) in group 1 and 19 days (range, 15e30 d) in group 2. There were no sig- nificant differences between the groups regarding their ages, initial extension lag, and arc of flexion. According to the Crawford classification criteria, 72% of the patients in group 1 had excellent results, and 59% of the patients in group 2 had excellent results. There was no significant difference between the groups. Conclusions The treatment results of patients with different presentation times have been reported for heterogeneous groups of osseous and nonosseous mallet finger injuries. Our results suggest that conservative management of tendinous mallet finger injuries that have been neglected for 2 to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates. (J Hand Surg Am. 2014;39(10):1982e1985. Copyright Ó 2014 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic III. Key words Deformity, finger, mallet, orthosis fabrication, tendon. S OFT TISSUE MALLET FINGER INJURY is generally caused by direct trauma that forces the extended finger into flexion at the distal interphalangeal (DIP) joint or by laceration of the extensor tendon at the level of the middle phalanx. 1 The tendon may be avulsed from the bone, or an avulsion fracture of the distal phalanx may occur. Acute, closed mallet finger injuries are treated by fabricating an orthosis for the DIP joint in mild hyperextension. 2 Delayed treatment of mallet finger injuries may cause unacceptable appearance, pain, and difficulties with grasp. 3 We aimed to compare the results of extension orthotic fabrication in the early and delayed presentation periods of isolated, closed, nonbony mallet finger de- formities. The time intervals were based on the biological differences in tendon healing before 2 weeks and be- tween 2 and 4 weeks following injury. 4 We hypothesized that patients with nonbony mallet fingers beginning conservative treatment between 2 and 4 weeks post injury would have similar functional outcomes to those who began treatment less than 2 weeks following injury. From the Orthopaedics and Traumatology Department, Selcuk University, Konya; the Orthopaedics and Traumatology Department, Agri State Hospital, Agri; the Manus Hand Surgery Center; and the Orthopaedics and Traumatology Department, Istanbul Bilim University, Manus Hand Surgery Center, Istanbul, Turkey. Received for publication January 30, 2014; accepted in revised form June 27, 2014. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Levent Yalçın, MD, Manus Hand Surgery Center, Sakayik Sokak 58/1, Nisantasi, Istanbul, 34365 Turkey; e-mail: aleventyalcin@gmail.com. 0363-5023/14/3910-0014$36.00/0 http://dx.doi.org/10.1016/j.jhsa.2014.06.140 1982 r Ó 2014 ASSH r Published by Elsevier, Inc. All rights reserved.