INTRODUCTION:The relative safety and effectiveness of percutaneous versus open A1 pulley release for trigger finger remain unclear. This systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) compares these two techniques and evaluates the potential benefits of ultrasound guidance in percutaneous release. MATERIALS AND METHODS:Following PRISMA guidelines, this SR and MA was conducted of RCTs published up to August 11, 2025. PubMed, Embase, and Cochrane Library were searched to identify studies comparing percutaneous release with open surgery for trigger finger. Outcomes assessed included function, pain, complications, and revision rates at immediate (1 week), short-term (<1 month), mid-term (3 months), and long-term (6 months) follow-up. Subgroup analysis examined ultrasound-guided versus non-ultrasound-guided percutaneous release. RESULTS:Fourteen RCTs involving 996 patients were included. Percutaneous release demonstrated significantly better outcomes in immediate (mean difference (MD): 24.94, 95 % CI: 11.82-38.06), short-term (MD: 15.08, 95 % CI: 10.25-19.92), and mid-term (MD: 7.27, 95 % CI: 2.36-12.19) Q-DASH scores, as well as time to return to work (MD: 12.82 days, 95 % CI: 10.00-15.63), and duration of postoperative analgesic use (MD: 4.66 days, 95 % CI: 1.77-7.55) (all p < 0.05). No significant differences were observed in long-term outcomes, including DASH scores, grip strength, motion, immediate and mid-term VAS, complications, or revision rates. CONCLUSION:Both percutaneous release and open surgery are effective treatments for trigger finger. Percutaneous release provides faster functional recovery, earlier return to daily activities, and reduced analgesic use, while maintaining comparable safety to open surgery.

BACKGROUND:Volar soft-tissue defects in digits necessitate reconstructions that restore appearance sensation and minimize complications. This study compared innervated toe pulp (TP) and noninnervated medialis pedis (MP) flaps for reconstructing such defects, focusing on objective and subjective outcomes. METHODS:Between 1998 and 2017, 101 free glabrous skin flap reconstructions were performed at the authors' institution for volar digital soft-tissue injuries, comprising 75 TP flaps and 26 MP flaps. Follow-up assessments included the Michigan Hand Outcomes Questionnaire; Disabilities of the Arm, Shoulder and Hand Questionnaire; Foot and Ankle Disability Index; and sensory testing (static and moving two-point discrimination, Semmes-Weinstein monofilament test). Data analysis used the Mann-Whitney U test and Pearson correlation coefficients. RESULTS:The study cohort included 29 participants (TP, n = 15; MP, n = 14) with an average follow-up of 106 months. Functional and sensory outcomes revealed no significant differences between TP flaps and MP flaps. Both flap types achieved satisfactory function and sensibility, with no statistically significant distinctions in patient-reported outcomes. Subjective complaints were similarly distributed across both groups, with a few reports of cold intolerance and discomfort at the donor site in the TP flap group. CONCLUSIONS:TP and MP flaps provide adequate coverage and sensory outcomes for volar digital defects without significant differences between innervated and noninnervated flap transfers. The flap choice should be tailored to individual patient needs and defect characteristics, emphasizing the importance of patient-centered decision-making in reconstructive surgery. Further research is required to explore the long-term outcomes of these reconstruction methods, especially for larger defects.

Background and Clinical Significance: Post-traumatic finger stiffness is frequently attributed to soft tissue adhesions; however, mechanical obstruction from occult osseous structures remains a rare but critical differential diagnosis in adults. Case Presentation: This report describes a 56-year-old female presenting with severe, refractory stiffness of the little finger eight months after a proximal phalanx fracture. Despite extensive conservative therapy, active and passive flexion at the proximal and distal interphalangeal joints remained locked in extension. While conventional radiographs demonstrated bony union, musculoskeletal ultrasonography (MSUS) revealed an occult protruding malunited fragment incarcerating the flexor tendons. Dynamic MSUS provided real-time evidence of mechanical impingement by demonstrating proximal muscle contraction without distal tendon excursion. Intraoperatively, initial soft tissue tenolysis failed to restore motion; further exploration guided by MSUS evidence successfully identified a sharp bone spike. Subsequent ostectomy resulted in immediate restoration of functional range of motion. This case underscores the limitations of static imaging in evaluating the dynamic gliding mechanism and highlights the valuable role of MSUS in identifying mechanical functional obstructions. Conclusions: Early sonographic evaluation should be considered for refractory post-traumatic stiffness to prevent prolonged, ineffective conservative care and to guide definitive surgical management.

INTRODUCTION:Vascularized toe proximal interphalangeal (PIP) joint transfer restores motion after destructive finger injuries, yet outcomes are limited by a persistent extensor lag. We observed subtendinous connective tissue attachment beneath the extensor digitorum longus (EDL), from the proximal phalangeal neck to the PIP joint, that may tether the tendon to bone. We assessed whether releasing this tissue improves surgical outcomes without compromising perfusion. METHODS:We performed a retrospective matched cohort study with a 1:1 propensity score matching on sex, age at surgery, native toe passive range of motion (ROM) and follow-up duration, comparing transfers with subtendinous tissue dissection to cases without dissection. Matched cohorts included 17 dissected and 17 non-dissected joints. The primary outcome was extension lag of the transferred PIP joint at final follow-up. Secondary outcomes included active PIP joint ROM, active flexion, percentage of use (active ROM ÷ donor toe passive ROM ×100), revision incidence and number of revision procedures per patient. Early follow-up was defined as 6 months postoperatively, and final follow-up as the most recent outpatient visit. Patients with follow-up <12 months were excluded. RESULTS:At the 6 month postoperative assessment, prior to any revision procedures, the dissected group demonstrated less extension lag (15° vs. 20°, p = 0.014) and greater ROM (55° vs. 45°, p = 0.017). At final follow-up, extension lag remained less (15° vs. 20°, p = 0.032), whereas ROM, flexion and percentage of use did not differ. The revision burden was similar between groups. CONCLUSION:Donor-side release of the subtendinous tissue beneath the EDL was associated with reduction in early and final extension lag without vascular compromise. These findings should be interpreted cautiously and warrant confirmation in larger studies with longer follow-up. LEVEL OF EVIDENCE:III.

BACKGROUND:Post-traumatic osteoarthritis of the proximal interphalangeal joint (PIPJ) substantially impairs hand function, and vascularized joint transfer (VJT) can be used to restore range of motion (ROM). However, malunion, particularly dorsal angulation of the proximal phalanx (P1), can occur postoperatively. We aimed to analyze the causes and impact of malunited P1 on surgical outcomes in VJT cases and provide insights regarding configuration and corrective osteotomy. METHODS:The authors retrospectively reviewed 61 VJT cases from 2008 to 2022, with the primary indication being PIPJ osteoarthritis and limited ROM. Malunion was defined as dorsal angulation >10°. Fixation methods and postoperative perfusion were analyzed. The primary outcome was PIPJ ROM, with particular focus on extension lag. RESULTS:Malunion and non-union were identified in 11 (18.0%) and 8 (13.1%) cases, respectively. The average sagittal angulation increased from 3.21° immediately after surgery to 8.23° at follow-up. Ten cases (16.4%) required corrective osteotomy. The average ROM achieved was 59.41°, with no significant difference between cases with and without malunion. Smokers had significantly poorer outcomes, including lower ROM (49.7° vs. 64.5°, p < 0.001) and greater extension lag (20.2° vs. 16.3°, p = 0.238). CONCLUSIONS:Shape discrepancy between the P1 shaft of the finger and toe complicates stable osteosynthesis during VJT, and the inherent nature of the muscles increases susceptibility to dorsal angulation malunion. Fixation method and transferred joint perfusion may be associated with malunion. No cause and effect relationship was found between P1 malunion with surgical outcomes. The decision to perform corrective osteotomy should consider other clinical factors.

Background:Wassel type IV is a common radial polydactyly anomaly characterized by duplication of the proximal phalanges at the metacarpophalangeal joint (MPJ). The primary goal of reconstructive surgery is to achieve a fully functional thumb with appropriate mobility, dimensions, and stable MPJ. This study aimed to compare the outcomes of MPJ reconstruction using either K-wire or non-K-wire fixation for Wassel type IV polydactyly. Methods:The study included 78 thumbs from 77 patients with Wassel Type IV polydactyly between April 2011 and December 2022. In addition to standard excision of duplicates, MPJ collateral ligament repair, and thenar muscle reattachment using a periosteal sleeve flap, the study analyzed the application of tendon transfer, soft-tissue augmentation, and K-wire fixation. Outcomes were evaluated using Tada score classification, MPJ deviation angle, and range of motion. Complications were also documented. Results:There was no significant difference in surgical outcomes based on Tada classification between the K-wire and non-K-wire fixation groups. Favorable outcomes were achieved in 76.3% and 84.2% of the K-wire and non-K-wire fixation groups, respectively. Although there was a significantly higher tissue augmentation rate in the K-wire fixation group, there were no significant differences in preoperative and postoperative MPJ angles between the 2 groups. Complications associated with K-wire fixation included pin tract infection (10.2%), migration (10.2%), and maceration (5.1%). Conclusions:Both K-wire and non-K-wire fixation approaches for Wassel type IV polydactyly yielded favorable subjective and objective outcomes. However, complications associated with K-wire fixation should be considered when determining the surgical approach.

Background Postoperative monitoring after free flap transfer is challenging, and clinical observation alone remains subjective and unquantifiable. Furthermore, re-explored flaps often have a poor appearance, making it challenging for surgeons to decide whether further aggressive treatments are necessary. Laser Doppler (LD) imaging can provide noninvasive, real-time, and quantifiable monitoring for flap perfusion. This study aimed to utilize fixed-timing LD to assist in postoperative free flap monitoring, especially in re-explored flaps. Material and Methods We retrospectively analyzed free anterolateral thigh (ALT) flap transfers with at least 1 re-exploration surgery from 2018 to 2022. Fixed-timing LD scans were conducted once a day on weekdays, and the flux mean of the flap and its adjacent reference healthy skin was obtained via an LD imager. The perfusion index (PI) was calculated as the percentage difference of flux mean between the flap and the reference. Timing of compromise, surgical findings and flap outcomes were recorded. Re-explored cases were matched with non–re-explored cases by propensity score matching for age, sex, and recipient site. Receiver operating characteristic curves and Youden's index were used to identify a PI cutoff value to define flap compromise. Post re-exploration outcomes were categorized into flap survival, partial necrosis, and failure. Post re-exploration LD data were analyzed with the Wilcoxon test. Results Forty-seven re-explored free ALT flaps were included. Ten re-explored cases with LD scans before compromise on postoperative day 1 were matched with 20 nonreopened cases. A PI threshold value < −0.62 could identify flap compromise with 80% sensitivity and 70% specificity. In the flap survival group, the mean PI mean was −0.61 ± 0.03 in 32 cases within 24 hours after re-exploration, which was higher than the PI threshold. A significant difference in PI mean was found between the survival and partial necrosis groups (−0.61 ± 0.03 vs −0.86 ± 0.02, P = 0.034). Conclusions When facing uncertain circulation after free flap transfers, LD imaging can provide reliable and objective method for postoperative monitoring. A PI value ≤ −0.62 could identify free ALT flap compromise. This PI threshold value could be applied to re-explored flaps, providing an option to evaluate those in which compromise is suspected.

INTRODUCTION:We investigated the outcomes of patients with severe ulnar nerve compression who underwent anterior interosseous nerve transfer combined with cubital and ulnar tunnel release. METHODS:Twenty-eight patients with McGowan IIB or III ulnar neuropathy caused by compression and with compound muscle action potentials of the ulnar intrinsics less than 3 mV were prospectively recruited for outcome analysis. Clinical signs of ulnar palsy, two-point discrimination tests, gripping and pinching force and electrophysiological studies were recorded over a 2 year follow-up. RESULTS:Significant improvement was observed in most features by 6 months after surgery. Subgroup analysis by aetiology at 2 years revealed no statistically significant differences in the recorded variables between individuals with previous trauma and those with idiopathic ulnar palsy. CONCLUSION:Anterior interosseous nerve transfer, along with cubital and ulnar tunnel release, results in sustained clinical and electrophysiological improvements in patients with severe chronic ulnar nerve compression, which encourages its adoption as a standard treatment for severe chronic ulnar nerve compression. LEVEL OF EVIDENCE:IV.

Vascularized toe proximal interphalangeal joint transfer has evolved as a biological solution for posttraumatic finger joint reconstruction. Extension lag has been recognized as a major challenge since its introduction in the 1980s. A significant advancement came from the 2013 anatomical study that characterized two distinct patterns of toe extensor mechanism: Type 1 (>95%) lacking obvious central slip insertion, and Type 2 (<5%) with clear central slip insertion. This understanding led to customized reconstruction strategies based on both donor toe anatomy and recipient finger condition. Various techniques, including centralization, direct repair, and central slip reconstruction, have been developed. The Te technique was developed to minimize bone manipulation while achieving similar functional outcomes to the traditional Stack technique. Current evidence demonstrates that proper execution of central slip reconstruction can achieve consistent functional results regardless of the technique chosen.

Microsurgical toe-to-hand transfer has revolutionized the reconstruction of missing thumbs and fingers, either from trauma or congenital etiologies, since its introduction in the late 1960s. The subsequent developments by global pioneers have made it a reliable surgical procedure with good functional and aesthetic results, yet acceptable donor site morbidities. This review article aims to highlight some significant concepts, surgical skills, and reconstruction strategies developed at Chang Gung Memorial Hospital over the past four decades, which are pivotal to the current landscape of toe-to-hand transfers practice. Avoiding unnecessary shortening of bone, joint, neurovascular bundle, tendon, and pulley in the amputation stump at the initial emergency management, provision of adequate coverage, and several other factors are essential for good results. Retrograde dissection of the vascular pedicle facilitates a quick and safe toe harvest for less experienced surgeons. Developing a modified great toe and lesser toe wrap-around flap, trimmed great toe, and combined second and third toes allows for optimal thumb and finger reconstruction even for challenging metacarpal hands. Both preservation of the proximal 1 cm of proximal phalanx in the remaining great toe and inclusion of a smaller skin flap from the foot, especially in combined second and third toes transfer for primary wound closure, can ensure minimal donor site morbidities.

Background: Posttraumatic proximal interphalangeal joint (PIPJ) flexion contracture is a common but difficult problem. Comprehensive literature is sparse, with inconsistent surgical techniques and outcomes. In this study, we describe in detail the volar approach of stepwise release and evaluate the outcomes of using the proximal interphalangeal joint adipofascial flap (PIPJAF) to cover the volar capsule of PIPJ. Methods: In this retrospective cohort study spanning over 12 years, we compared 19 patients with PIPJAF and 16 patients without PIPJAF, with a minimum follow-up of 6 months postoperatively. Results: In the PIPJAF group, there was significant improvement in active flexion arc (70.8°, SD 18.6°) at 6 months, and at 6 months and later significantly better extension lag angle (20.8°, SD 19.2°), improvement in extensor lag angle (29.2°, SD 15.3°), and improvement ratio (0.62, SD 0.33) were observed. Conclusions: There is a modest mid-term benefit in using the PIPJAF. We propose integrating the volar approach with PIPJAF in suitable patients with adequate adipofascial tissue on the lateral aspect of the finger. Level of evidence: III – retrospective cohort study.

Summary: Correction of a boutonnière deformity is one of the most demanding challenges in hand surgery. Surgical interventions are usually considered when functional use of the finger cannot be obtained after intense hand therapy. The authors introduce their newly described lambda (λ) repair, which is an easy-to-learn, straightforward surgical technique. The method involves an end-to-side tenorrhaphy of the lateral bands, resembling the Greek λ. Patients who underwent a lambda repair were retrospectively evaluated with preoperative and postoperative measurements of proximal interphalangeal (PIP) joint movement. Four patients (two male, two female; median age, 35.5 years) with a median follow-up period of 9.1 months were included. Three patients underwent lambda repairs for isolated boutonnière deformities, and one patient received a vascularized free toe transfer combined with a lambda repair. The preoperative average PIP joint extension lag or deficit was 28.75 degrees and could be reduced to 15 degrees. Preoperative average PIP joint active flexion was 60 degrees, which was improved to 88.75 degrees. No complications were observed. The lambda repair is a new tool in the reconstruction of boutonnière deformity, further expanding the armamentarium of hand surgeons.

BACKGROUND:Deep sternal wound infection (DSWI) is a severe and life-threatening complication following cardiovascular surgery. Negative pressure wound therapy (NPWT) has emerged as a promising therapeutic bridging option for DSWI. In this systematic review and meta-analysis, the authors aimed to evaluate the impact of NPWT on clinical outcomes in patients with DSWI. MATERIAL AND METHODS:A comprehensive literature search was conducted according to the PRISMA guideline in electronic databases, including PubMed, Embase, and Cochrane Library. Data extraction was performed independently by two reviewers, and risk of bias was assessed by ROBINS-I tool. The primary outcomes assessed were mortality rate and reinfection rate. The secondary outcomes assessed were length of hospital stay and ICU stay. RESULTS:In this systematic review identified a total of 36 studies, comprising 3681 patients with DSWI who received treatment. The meta-analysis revealed that NPWT was associated with a significant reduction in mortality rate (RR 0.46, 95% CI: 0.35-0.61, P<0.000001) and reinfection rate (RR 0.43, 95% CI: 0.25-0.74, P=0.002) compared to conventional wound management. Furthermore, pooling of these studies showed significant difference between the NPWT and conventional treatment groups in length of hospital stay (mean difference: -4.49, 95% CI: -8.14 to -0.83; P=0.02) and length of ICU stay (mean difference: -1.11, 95% CI: -2.18 to -0.04; P=0.04). CONCLUSION:This systematic review and meta-analysis provide evidence that NPWT is superior to conventional treatment for patients with DSWI following cardiovascular surgery.

Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and preserving the major knee joint are crucial to enhance mobility and overall functionality. By providing painless soft tissue coverage on the stump, early prosthesis use and the initiation of physiotherapy become more feasible. Soft tissue transfers hold the potential to benefit patients in two essential aspects: first, resolving soft tissue deficiencies without causing bone shortening, and second, preparing the stump to enhance overall functionality. A retrospective study conducted at Chang Gung Memorial Hospital (2009–2016) focused on lower limb amputation patients who underwent soft tissue transfers at different time periods compared to those without stump reconstruction. Out of the 2391 cases of lower limb injuries treated operatively, 117 amputations were performed in 110 patients (44 above the knee and 73 below the knee). Among them, 12 patients received soft tissue transfers for limb salvage and soft tissue deficiency after amputations. It was observed that patients in this group were typically younger, predominantly female, had longer hospital stays, and underwent a greater number of surgical procedures (p < 0.05). Through the use of soft tissue transfers, successfully preserved tibial bone length and functional knee joint in selected patients was achieved. This approach effectively resolved soft tissue deficiencies following lower limb amputations, optimizing physiotherapy and facilitating functional rehabilitation.

BackgroundHigh ulnar nerve injuries result in intrinsic muscle weakness and are inconvenient for patients. Moreover, conventional surgical techniques often fail to achieve satisfactory motor recovery. A potential reconstructive solution in the form of the supercharge end-to-side (SETS) anterior interosseous nerve (AIN) transfer method has emerged. Therefore, this study aims to compare surgical outcomes of patients with transected and in-continuity high ulnar nerve lesions following SETS AIN transfer.MethodsBetween June 2015 and May 2023, patients with high ulnar palsy in the form of transection injuries or lesion-in-continuity were recruited. The assessment encompassed several objective results, including grip strength, key pinch strength, compound muscle action potential, sensory nerve action potential, and two-point discrimination tests. The muscle power of finger abduction and adduction was also recorded. Additionally, subjective questionnaires were utilized to collect data on patient-reported outcomes. Overall, the patients were followed up for up to 2 years.ResultsPatients with transected high ulnar nerve lesions exhibited worse baseline performance than those with lesion-in-continuity, including motor and sensory functions. However, they experienced greater motor improvement but less sensory recovery, resulting in comparable final motor outcomes in both groups. In contrast, the transection group showed worse sensory outcomes.ConclusionsOur findings suggest that SETS AIN transfer benefits patients with high ulnar nerve palsy, regardless of the lesion type. Nonetheless, improvements may be more pronounced in patients with transected lesions.

Objective Open tibial fractures are frequently encountered in high‐energy traumas and can result in significant complications such as nonunion, osteomyelitis, and even amputation. Among open tibial fractures, Gustilo type IIIC cases are particularly challenging due to the concomitant occurrence of neurovascular injuries and soft tissue defects. This study aimed to assess factors that affect union time and complications in Gustilo IIIC tibial fractures. Methods Patients who presented at our center with IIIC open tibial fractures from January 2000 to October 2020 were eligible for this retrospective analysis. Patient demographics, fracture characteristics, and the timing, number, and type of surgical intervention were documented. Outcomes of interest included union time, occurrence of osteomyelitis, and amputation. We performed univariate analyses including chi‐squared test, Fischer's exact test, analysis of variance, and Kruskal–Wallis test based on the normality of the data and multivariate analyses including Cox proportional hazards model and logistic regression analyses. Results Fifty‐eight patients were enrolled and grouped by fracture healing time; eight had timely union (13.8%); 27 had late union (46.6%); eight had delayed union (13.8%); three had nonunion (5.2%); and 12 underwent amputation (20.7%). Nine fractures (15.5%) were complicated by osteomyelitis. Union time was prolonged in cases of triple arterial injury, distal third fractures, multiple trauma with injury severity score (ISS) ≥ 16 points, and increased bone defect length. Additionally, a bone gap >50 mm, diabetes mellitus, low body mass index, and triple arterial injury in the lower leg were significant risk factors for amputation. A time from injury to definitive soft tissue coverage of more than 22 days was the major risk factor for osteomyelitis. A scoring system to predict union time was devised and the predicted probability of union within 2 years was stratified based on this score. Conclusion IIIC tibial fractures involving the distal third of the tibia, fractures with bone defects, triple arterial injury, and multiple trauma with ISS ≥16 points demonstrated delayed union, and an effective prediction system for union time was introduced in this study. Early soft tissue coverage can reduce the risk of osteomyelitis. Finally, diabetes and severe bone and soft tissue defects pose a higher risk of amputation.

Background: Significant extension deficit is a common problem after a vascularized toe proximal interphalangeal joint transfer. One of the main causes related to extensor lag is central slip deficiency of the donor toes. In our clinical practice, we performed both the Stack and Te technique to reconstruct central slip function during a joint transfer. The aim of this study was to compare the long-term outcomes of vascularized joint transfers between these two techniques. Patients and Methods: From May 2009 to October 2021, 38 digits in 36 patients (28 men and 8 women) underwent free vascularized toe joint transfer requiring central slip reconstruction. Eight and 30 digits were reconstructed with the Stack and Te technique, respectively. Results: The median length of follow-up was 19 months (range, 5 to 78 months). The overall median extension lag was 20±20 degrees and the flexion was 80±20 degrees. There were no significant differences in extension lag (25±29 vs. 20±15 degrees, p = 0.281), flexion (75±10 vs. 85±20 degrees, p = 0.13), and range of motion (53±23 vs. 63±15 degrees, p = 0.076) of the joints between the Stack and Te techniques after the transfers. Conclusions: From the limited number of cases, both the Stack and Te techniques provided similar outcomes in correcting extension lag in vascularized joint transfers. The Te technique is a simplified and effective method for central slip reconstruction, while caution is advised when using the Stack technique due to potential complications. Clinical question/level of evidence: Therapeutic, IV.

BACKGROUND:Ulnar tunnel syndrome (UTS) is relatively uncommon compared to the carpal tunnel or cubital tunnel syndromes. Few reports dedicated to the functional outcomes after surgical intervention of the UTS exist. Herein we compare the outcomes of patients with UTS of different etiologies.METHODS:Patients diagnosed with UTS between 2016 and 2020 were recruited. Ulnar tunnel release was performed in all patients, along with other necessary osteosynthesis or reconstructive procedures in the traumatic group. Patients were followed-up every six months post-operatively. Outcomes measured include: objective evaluations, subjective questionnaires, records of clinical signs, and grading of the British Medical Research Council scale for intrinsic muscle strength.RESULTS:21 patients were recruited, and favorable results were noted in all of them after surgery. Traumatic UTS patients had a worse initial presentation than the non-traumatic cases, but had a greater improvement after surgery and yielded outcomes comparable with those of the patients without trauma. Patients with aberrant muscles in their wrists had better outcomes in some objective measurements than those without aberrant muscles.CONCLUSIONS:Ulnar tunnel release improves the outcome of patients regardless of the etiology, especially in patients with trauma-induced UTS. Thus, a proper diagnosis of the UTS should be alerted in all patients encountering paresthesia in the ulnar digits, ulnar-sided pain, weakness of grip strength, or intrinsic weakness to ensure good outcomes.

Mallet finger is a commonly encountered condition in daily practice. However, there is currently no consensus on whether surgical intervention or conservative treatment with orthosis splint is superior. In this systematic review and meta-analysis, we compare the treatment outcomes between surgery and orthosis for bony and tendinous mallet finger. We searched PubMed, Embase, and the Cochrane Library according to the PRISMA guidelines from inception to January 15, 2021. The primary outcome was distal interphalangeal (DIP) joint extension lag angle, and secondary outcomes were DIP joint flexion and range of motion (ROM) angle. A total of 297 studies were initially identified, of which 13 (ten retrospective non-randomized controlled studies (non-RCTs) and three RCTs) were included in the final analysis. The results of this systematic review and meta-analysis showed that there was no high level of evidence supporting the superiority of surgery over orthosis in the treatment of mallet finger. Based on the available evidence, surgical intervention and conservative treatment with splint may offer similar clinical outcomes in both bony and tendinous mallet finger.