Incidence and management of mallet finger in Dutch primary care

Background A mallet finger (MF) is diagnosed clinically and can be managed in primary care. The actual incidence and management of MFs in primary care is unknown.

Aims To determine the incidence of MFs in primary care and to obtain estimates for the proportions of osseous and tendon MFs. Additionally, to gain insight in the management of patient diagnosed with a MF in primary care.

Design and setting A cohort study using a healthcare registration database from general practice.

Method Patients aged ≥18 years with a new diagnosis of a MF from 1 January 2015 to 31 December 2019 were selected using a search algorithm based on International Classification of Primary Health Care coding.

Results In total, 161 MF cases were identified. The mean incidence was 0.58 per 1,000 persons–years. In 58% (n=93) of the cases, a radiograph was taken; 23% (n=37) of MF cases had an osseous MF. The most applied strategies were referral to secondary care (45%) or conservative treatment in GP practice (43%). 11% was referred to a paramedical professional.

Conclusion On average, a GP assesses ±1 patient with a MF per year. Since only a minimal number of patients required surgical treatment and a limited number of GPs requested radiography, the recommendation in the guidelines to perform radiography in all patients with MF should potentially be reconsidered. The purpose of requesting radiographs should not be to distinguish between a tendinogenic or osseous MF, but to assess whether there is a possible indication for surgery.