Abstract
Background
Non-operative cases of mallet finger can be followed up by the hand therapists. Both trust and national policies encourage appropriate indication for follow-up in fracture clinic & cost-effective approach without affecting the patient care.
Aims
To reduce unnecessary fracture clinic follow up for Mallet finger injuries.
Methods
Management for uncomplicated mallet finger injuries is provided by hand therapy and does not need surgical input. Hand Surgeons in the department agreed to a management protocol for Mallet finger injuries, to streamline patient management and save costs. All Mallet finger injuries less than 6 weeks old not requiring surgery to be referred for hand therapy at the first appointment in fracture clinic and left with an open appointment. Retrospective audit of all patients referred to hand therapy in 2015 (Jan-Dec) done to identify extra appointments.
Results
Inclusion criteria: All mallet fingers seen in fracture clinic
Exclusion criteria: > 6-week-old injury at presentation, Patients requiring surgery (joint subluxation).
Retrospective first Audit (01/01/2015-31/12/2015):
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55 patients identified fulfilling inclusion criteria.
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33 patients had delayed referral to hand therapists (12–107 days)
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37 patients had extra fracture clinic appointments totalling 72 appointments
Prospective re-audit (01/10/2016 – 31/12/2016):
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16 patients met inclusion criteria
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Number of patients referred in their first fracture clinic: 10 patients.
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Other 6 patients had mean delay 20 days.
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Potential cost saving in fracture clinic for the trust over a year of £4730
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Extra-fracture clinic in 7 patients, but 3 were clinically indicated (review to check possible subluxation) i.e. only 4 wasted clinic appointments
Conclusions
By restructuring our management for Mallet fingers we have streamlined the service. There is early referral to hand therapy, reduced fracture clinic appointments, decreasing pressure on fracture clinics, enhanced patient experience and cost savings for the trust.
