What is known from the existing literature about the treatment of Mallet Injury using 3D printed splints? A Scoping Review Protocol

Una M. Cronin; Alice Shannon; Micheal ó hAodha; Aidan O'Sullivan; Niamh M. Cummins; Leonard OSullivan

doi:10.12688/hrbopenres.13865.1

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What is known from the existing literature about the treatment of Mallet Injury using 3D printed splints? A Scoping Review Protocol

[version 1; peer review: 1 approved with reservations]

Una M. Cronin^1,2, Alice Shannon^1,3, Micheal ó hAodha⁴, Aidan O'Sullivan¹, Niamh M. Cummins^1,2,5,6, Leonard OSullivan ^1,2

Una M. Cronin^1,2, Alice Shannon^1,3, [...] Micheal ó hAodha⁴, Aidan O'Sullivan¹, Niamh M. Cummins^1,2,5,6, Leonard OSullivan ^1,2

PUBLISHED 24 Apr 2024

Author details Author details

¹ Rapid Innovation Unit, Confirm Centre for Smart Manufacturing, University of Limerick, Limerick, County Limerick, Ireland
² Health Research Institute, University of Limerick, Limerick, County Limerick, Ireland
³ National Children's Research Centre, Crumlin, County Dublin, Ireland
⁴ Faculty Librarian (Science, Engineering and Architecture), Glucksman Library, University of Limerick, Limerick, County Limerick, Ireland
⁵ School of Medicine, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health. Faculty of Education and Health Sciences,, University of Limerick, Limerick, County Limerick, Ireland
⁶ Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Melbourne, Australia

Una M. Cronin
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Alice Shannon
Roles: Data Curation, Formal Analysis, Validation

Micheal ó hAodha
Roles: Data Curation, Formal Analysis

Aidan O'Sullivan
Roles: Conceptualization, Investigation, Methodology, Supervision, Validation, Writing – Review & Editing

Niamh M. Cummins
Roles: Conceptualization, Data Curation, Investigation, Methodology, Supervision, Validation, Writing – Review & Editing

Leonard OSullivan
Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Mallet finger injuries are a frequent cause of hospital attendance, being the fifth most common injury in the body. They are therefore a frequent cause of hospital visits. To date, these injuries have primarily been managed using generic splints. As a generic splint provides a generic fit, patients who receive these are not provided with a custom splint experience. As the size and fit of these splints are not bespoke to the patient’s anatomy, patients may not always find the fit comfortable and may find complying with these splints difficult at times. However, an opportunity is developing within healthcare where custom splinting can be obtained for some using Three-D (3D) printing. The rationale for this review is to gain an understanding of the research that has been conducted on 3D printing of mallet injury splints.

Objective

The objective of this scoping review is to map the current literature on 3D printing associated with mallet finger injury.

Methods

The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used throughout along with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Two researchers will search the databases that will include CINAHL, Embase, Cochrane, EbscoHost, Medline/Pubmed, Science Direct, Web of Science, and Google Scholar. The search will include grey literature and a hand search of sources falling outside the chosen databases. Screen titles, abstracts, and full-text articles will be reviewed by two researchers independently using Rayaan software. The data extracted from the literature will first be presented in a tabulated chart followed by a narrative synthesis.

Registration

The protocol was registered on 6th September 2023, with the Open Science Framework. Registration DOI: https://doi.org/10.17605/OSF.IO/FSJPK

Keywords

Mallet injury, 3D printing

Corresponding author: Leonard OSullivan

Competing interests: No competing interests were disclosed.

Grant information: This publication has emanated from research supported by Science Foundation Ireland (SFI) under Grant Numbers SFI 16/RC/3918 and SFI 20/COV/0031, co-funded by the European Regional Development Fund.
Alice Shannon (AS) is funded by the National Childrens Research and Irish Research Council.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 Cronin UM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Cronin UM, Shannon A, ó hAodha M et al. What is known from the existing literature about the treatment of Mallet Injury using 3D printed splints? A Scoping Review Protocol [version 1; peer review: 1 approved with reservations]. HRB Open Res 2024, 7:21 (https://doi.org/10.12688/hrbopenres.13865.1) First published: 24 Apr 2024, 7:21 (https://doi.org/10.12688/hrbopenres.13865.1) Latest published: 16 Aug 2024, 7:21 (https://doi.org/10.12688/hrbopenres.13865.2)

Introduction

Mallet finger is a common finger injury. It occurs when the distal interphalangeal joint (DIPj) is unable to extend, usually following trauma to the distal phalynx¹. In mallet injuries, the tendon is partially torn or experiences a complete rupture². An avulsion fracture can also occur. Mallet finger injuries are often caused by trauma, such as a forceful blow to the DIPj³.

Uncomplicated cases of mallet injury are treated with immobilisation of the DIPj, where the joint is held in extension for 6–8 weeks using a splint⁴. The splint must be worn continuously to keep an upward force on the injured finger until the tendon injury or fracture heals. If the splint is removed and the injured finger bends, the extensor tendon can re-rupture, meaning the splinting process needs to be repeated, which can delay healing by a number of weeks⁵.

There are many splint variations available in healthcare facilities, with most studies reporting similar results^6–8. Although no gold standard exists regarding the optimum splint to use for the treatment of mallet injury, many options are available. Some examples include generic Stack splints, aluminum foam splints, dorsal glue splints and custom thermoplastic splints⁹.

A systematic review conducted in 2015 compared custom-made finger splints with pre-fabricated splints¹⁰. They found custom splinting resulted in less skin complications as compared with custom-made splints. Another study conducted in 2022, recommended clinicians should use custom splints to best provide complete immobilisation of the DIPj which is essential to ensure recovery from the injury¹¹. Although generic and custom splints are available within some healthcare facilities, they do have documented complications. Examples of these include skin complications, the splint being bulky, not being waterproof and not being well ventilated¹².

However, the emerging field of 3D printing is showing promising alternatives to generic and hand moulded custom splints. 3D printing involves printing materials by reading a digital blueprint and then printing the object layer by layer. The benefits offered by 3D printing include cost effective prototyping, time efficient modelling, the manufacture of complex geometries¹³. Most recently, 3D printing has been adapted to directly treat patients, moving away from its initial application for anatomical modelling to aid in education and planning for procedures¹⁴. Advances in 3D printing technology and experience have led to increased clinical use, including in personalised healthcare solutions¹⁵. There is now an opportunity to provide custom care to patients suffering from mallet injury using 3D printing. To progress this concept, it is essential to gain an understanding of the research conducted on this topic thus far.

To date, some reviews have been conducted within the domain of 3D printing splints and orthoses^12,16–18. The most relevant review to our realm of interest was conducted by Oud in 2021¹². Their review primarily focused on 3D-printed orthosis for hand conditions secondary to trauma, with a concentration on their effect. They found the literature consisted of low patient numbers and had poor methodological quality. They highlighted there is an opportunity for high-quality controlled trials¹².

The broad scope and autonomy afforded in Scoping Reviews provide a template to identify the main concepts and themes along with the research gaps associated with 3D printing and mallet splints. As this area is a novel development, the associated literature may lack high quality and homogeneous studies. A preliminary google search uncovered relevant literature available in healthcare journals. To that end, a scoping review was chosen to allow an exploration of the breadth of published and grey literature on the topic of the treatment of mallet injury using 3D-printed splints. A holistic synthesis of the available evidence will be conducted, while locating gaps in the research and highlighting areas for further research focus.

Aim and review question

This scoping review aims to deliver a thorough comprehension of all the research available on the topic of 3D-printing of mallet splints. The JBI methodology for scoping reviews will be utilised to conduct this scoping review¹⁹.

The Population Concept Context (PCC) framework guided the development of the main research questions as follows:

Participants

Eligible studies will include participants of any age with mallet injury due to trauma.

Concept

The phenomenon of interest is 3D printing of mallet splints.

Context

As 3D printing of mallet splints is a novel and emerging field, we felt it important to include both clinical and research settings. The preliminary search of the literature identified some studies detailing the design and print of mallet splints not designed for or placed on specific patients with mallet injuries. These studies describe the process and science emerging around 3D printing of mallet splints in the research setting, thus will be included as they will add a further layer of experience to the clinical studies.

The sub-questions underpinning this overarching question include:

1. What techniques and processes (examples being measuring, printing, securing) are most frequently used for 3D printing mallet splints on patients and in research settings?
2. What is the potential for 3D printing of mallet splints in the clinical field/ point of care?

Eligibility criteria

Inclusion criteria

Studies that report on 3D printing of mallet splints or 3D printing for mallet injury.
Literature published since 1980. The earliest applications of 3D printing were in the 1980’s therefore the search will range from 1980 to end of September 2023²⁰.
Only full-text publications will be included.
Articles published in English only.
Grey literature including studies and reports that mention 3D printing of mallet splints.

Exclusion criteria

There are no specific exclusion criteria.

Types of sources

All study methodologies will be considered in this review. Both qualitative and quantitative data will also be included in the review. Text and opinion papers will also be considered for inclusion in this scoping review.

Methods

A preliminary search of Embase, CINAHL, Cochrane, PUBMED (Medline), Google Scholar and JBI Evidence Synthesis was conducted on September 6^th 2023. No past or ongoing scoping reviews on this subject were discovered.

The review was conducted using the JBI methodology guidance for scoping reviews. The protocol was registered on the 6^th of September 2023 with the Open Science Framework.

Search strategy

The search strategy will be created in association with a specialist librarian (MOH). The review will include both published and unpublished literature. The search strategy will be iterative throughout with the first step involving a literature search of the subsequent databases: CINAHL, EMBASE, Science Direct, Cochrane, Web of Science, MEDLINE (Pubmed), and Google Scholar. The search strategy will involve the combining of medical subject headings (MESH) and Boolean Operators. Identified keywords and English language filters will be applied. Each indexed database will include an adapted search strategy. Following this, the reference lists of each included study will be examined. The authors of eligible studies will be contacted as needed for extra material or to clarify any unclear areas in the literature. The published review will include the entire search strategy and results. The search strategy is presented in Table 1.

Table 1. Proposed search strategy.

Database	Exact search
Ebscohost	mallet AND ("additive manufacturing" or "3d printing" or "3-d printing" or "three-dimensional printing")
EMBASE	mallet AND ("additive manufacturing" or "3d printing" or "3-d printing" or "three-dimensional printing")
Scopus	mallet (title, abstract, keywords) AND ("additive manufacturing" or "3d printing" or "3-d printing" or "three-dimensional printing") (title, abstract, keywords)
Pubmed	mallet AND ("additive manufacturing" or "3d printing" or "3-d printing" or "three-dimensional printing")
Web of Science	mallet AND ("additive manufacturing" or "3d printing" or "3-d printing" or "three-dimensional printing")
Science direct	mallet (title, abstract, keywords) AND ("additive manufacturing" or "3d printing" or "3-d printing" or "three-dimensional printing") (title, abstract, keywords)

Study/source of evidence selection

After completing the search, all relevant references will be inserted post-collating into Endnote X8 (Clarivate Analytics, PA, USA). The screening process will be carried out using Rayaan, a web-based literature screening program. Duplicates will then be deleted. Two reviewers (UC and AS) will conduct a pilot test (n=5) by screening the title and abstracts of the search using the set eligibility criteria. Following this, the full manuscript of each chosen literature will be reviewed using the predetermined eligibility criteria. The sources of evidence excluded at full text will be recorded and detailed in this review. A ‘snowball’ search methodology will be adopted by reviewing the reference lists of the chosen studies to aid in identifying any literature that was not captured in the initial search. Any conflicts in relation to inclusion of specific literature will be discussed, and if not resolved, a third reviewer (NC) will be consulted. All outcomes of the literature search and the process of inclusion and exclusion will be presented clearly in the final paper.

Data extraction

A data extraction tool will be created by the researchers to aid the information extraction process. The extracted data shall provide detail on the participants, concept and context of each paper. The study methodologies utilised, along with all data relevant to the review question, what is known from the existing literature regarding the treatment of mallet injury using 3D-printed splints will be presented.

Table 2 displays the initial draft data extraction tool created by two researchers. As is typical for scoping reviews, the data extraction tool will be modified as needed throughout the iterative process of information review and extraction. Any modifications made to the data extraction tool will be presented clearly in the final review. Again, any conflicts in decisions regarding inclusion and exclusion of data that arise will be discussed and resolved if needed by a third reviewer. If additional information is needed, the relevant authors of the paper will be communicated with to provide clarity or supplementary data. The purpose of the scoping review is to describe current practices relating to the 3D-printing of mallet splints thus a critical appraisal of the methodological quality of each paper is not essential.

Table 2. Adapted data charting form from Joanna Briggs Institute (JBI) methodology for scoping reviews¹⁶.

Citation details

Inclusion/Exclusion criteria

Context

Study design (RCT etc)

Study populations/sample size/injured, non-injured

Methodology

Adverse events

Endpoints

Limitations

Specifics of splints

Sustainability

How secured

How measured

Printer/material used

Mention of compliance

Process used

Skin integrity/ventilation

Data analysis and presentation

All data will first be introduced in a descriptive manner, using tables and charts to aid the explanation of the results. A narrative summary will also be included. This approach ensures a logical and descriptive summary that conforms with the objective of scoping reviews. The PRISMA-ScR will be used to guide the report²¹.

Registration: The protocol was registered on 6^th September 2023, with the Open Science Framework. Registration DOI: https://doi.org/10.17605/OSF.IO/FSJPK

Data availability

No data are associated with this article.

Faculty Opinions recommended

References

1. Khera B, Chang C, Bhat W: An overview of mallet finger injuries. Acta Biomed. 2021; 92(5): e2021246. PubMed Abstract | Publisher Full Text | Free Full Text
2. Alla SR, Deal ND, Dempsey IJ: Current concepts: mallet finger. Hand (N Y). 2014; 9(2): 138–44. PubMed Abstract | Publisher Full Text | Free Full Text
3. Handoll HHG, Vaghela MV: Interventions for treating mallet finger injuries. Cochrane Database Syst Rev. 2004; (3): CD004574. PubMed Abstract | Publisher Full Text
4. Mak L, Aitkens LD, Novak CB: Mallet finger injuries-A new method to maintain distal interphalangeal joint extension. J Hand Ther. 2016; 29(3): 352–5. PubMed Abstract | Publisher Full Text
5. Lin JS, Samora JB: Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am. 2018; 43(2): 146–163.e2. PubMed Abstract | Publisher Full Text
6. O'Brien LJ, Bailey MJ: Single blind, prospective, randomized controlled trial comparing dorsal aluminum and custom thermoplastic splints to stack splint for acute mallet finger. Arch Phys Med Rehabil. 2011; 92(2): 191–8. PubMed Abstract | Publisher Full Text
7. Pike J, Mulpuri K, Metzger M, et al.: Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger. J Hand Surg Am. 2010; 35(4): 580–8. PubMed Abstract | Publisher Full Text
8. Valdes K, Naughton N, Algar L: Conservative treatment of mallet finger: A systematic review. J Hand Ther. 2015; 28(3): 237–45. PubMed Abstract | Publisher Full Text
9. Acar E: The use of Stack splint or aluminum finger splint in the conservative management of acute Doyle type IVb bony mallet finger. J Orthop Sci. 2023; S0949-2658(23)00209-9. PubMed Abstract | Publisher Full Text
10. Witherow EJ, Peiris CL: Custom-Made Finger Orthoses Have Fewer Skin Complications Than Prefabricated Finger Orthoses in the Management of Mallet Injury: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2015; 96(10): 1913–23. PubMed Abstract | Publisher Full Text
11. Güven E, Suner-Keklik S: Custom-made finger splint versus prefabricated finger splint: finger flexion stabilization. Rev Assoc Med Bras (1992). 2022; 68(7): 935–938.e1. PubMed Abstract | Publisher Full Text | Free Full Text
12. Oud TAM, Lazzari E, Gijsbers HJH, et al.: Effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions: A scoping review. PLoS One. 2021; 16(11): e0260271. PubMed Abstract | Publisher Full Text | Free Full Text
13. Vaz VM, Kumar L: 3D Printing as a Promising Tool in Personalized Medicine. AAPS PharmSciTech. 2021; 22(1): 49. PubMed Abstract | Publisher Full Text | Free Full Text
14. Aimar A, Palermo A, Innocenti B: The Role of 3D Printing in Medical Applications: A State of the Art. J Healthc Eng. 2019; 2019: 5340616. PubMed Abstract | Publisher Full Text | Free Full Text
15. Al-Dulimi Z, Wallis M, Tan DK, et al.: 3D printing technology as innovative solutions for biomedical applications. Drug Discov Today. 2021; 26(2): 360–83. PubMed Abstract | Publisher Full Text
16. Chen RK, Jin YA, Wensman J, et al.: Additive manufacturing of custom orthoses and prostheses—A review. Additive Manufacturing. 2016; 12: 77–89. Publisher Full Text
17. Barrios-Muriel J, Romero-Sánchez F, Alonso-Sánchez FJ, et al.: Advances in Orthotic and Prosthetic Manufacturing: A Technology Review. Materials (Basel). 2020; 13(2): 295. PubMed Abstract | Publisher Full Text | Free Full Text
18. Cha YH, Lee KH, Ryu HJ, et al.: Ankle-Foot Orthosis Made by 3D Printing Technique and Automated Design Software. Appl Bionics Biomech. 2017; 2017: 9610468. PubMed Abstract | Publisher Full Text | Free Full Text
19. Peters MDJ, Marnie C, Tricco AC, et al.: Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18(10): 2119–26. PubMed Abstract | Publisher Full Text
20. Savini A, Savini G: A short history of 3D printing, a technological revolution just started. 2015 ICOHTEC/IEEE International History of High-Technologies and their Socio-Cultural Contexts Conference (HISTELCON). IEEE, 2015. Publisher Full Text
21. Tricco AC, Lillie E, Zarin W, et al.: A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016; 16: 15. PubMed Abstract | Publisher Full Text | Free Full Text

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Version 2

VERSION 2 PUBLISHED 24 Apr 2024

Author details Author details

Una M. Cronin
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Alice Shannon
Roles: Data Curation, Formal Analysis, Validation

Micheal ó hAodha
Roles: Data Curation, Formal Analysis

Aidan O'Sullivan
Roles: Conceptualization, Investigation, Methodology, Supervision, Validation, Writing – Review & Editing

Niamh M. Cummins
Roles: Conceptualization, Data Curation, Investigation, Methodology, Supervision, Validation, Writing – Review & Editing

Leonard OSullivan
Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This publication has emanated from research supported by Science Foundation Ireland (SFI) under Grant Numbers SFI 16/RC/3918 and SFI 20/COV/0031, co-funded by the European Regional Development Fund.
Alice Shannon (AS) is funded by the National Childrens Research and Irish Research Council.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (2)

version 2

Revised

Published: 16 Aug 2024, 7:21

https://doi.org/10.12688/hrbopenres.13865.2

version 1

Published: 24 Apr 2024, 7:21

https://doi.org/10.12688/hrbopenres.13865.1

© 2024 Cronin UM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cronin UM, Shannon A, ó hAodha M et al. What is known from the existing literature about the treatment of Mallet Injury using 3D printed splints? A Scoping Review Protocol [version 1; peer review: 1 approved with reservations]. HRB Open Res 2024, 7:21 (https://doi.org/10.12688/hrbopenres.13865.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

Version 1

VERSION 1

PUBLISHED 24 Apr 2024

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Reviewer Report 11 Jul 2024

Ryan Trickett, University Hospital of Wales, Cardiff, UK

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15195.r41020

In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely very similar injuries in terms of mechanism and outcome – true hyperflexion injuries and usually relatively low energy trauma.

So-called bony mallet fractures, particularly those involving a larger proportion of the articular surface are much more likely to be an alternative mechanism – axial loading associated with EXTENSION of the distal joint – with a greater force of injury. These injuries conversely are often best treated with slight flexion, particularly where there is articular incongruence. All mallet injuries are often clumped together in the literature but should be clearly defined in the introduction and the inclusion criteria should be clear in this regard too.

Participants – soft tissue and/or bony and/or hyperextension injuries (see above)?

Why has September 2023 been chosen as an end date to the searches?

Can the authors be more specific around their searching of the “grey literature"? It is also odd that only “full-text” articles are being included, but grey literature is being included. The 2 statements seem at odds with one another.

Has chronicity of mallet finger been considered in the inclusion criteria?

Why have non-English articles been excluded? This potentially adds a selection bias.

I worry that the search will yield no usable outcomes data and simply demonstrate what we almost certainly know already – that there is an almost complete lack of literature around 3D printing of mallet splints. A quick search using the search strategy – which seems to be somewhat restrictive – shows only 2 relevant articles.

Why was mallet finger chosen specifically for this review?

Perhaps a more useful review could be “3D printing splints for the treatment of closed digital tendon injuries” which could include mallets and Boutonniere’s; or an even wider scope to include open tendon injuries?

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Hand trauma and surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 16 Aug 2024

Leonard OSullivan, Rapid Innovation Unit, Confirm Centre for Smart Manufacturing, University of Limerick, Limerick, Ireland

16 Aug 2024

Author Response

Comment 1: In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely ... Continue reading Comment 1: In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely very similar injuries in terms of mechanism and outcome – true hyperflexion injuries and usually relatively low energy trauma.

So-called bony mallet fractures, particularly those involving a larger proportion of the articular surface are much more likely to be an alternative mechanism – axial loading associated with EXTENSION of the distal joint – with a greater force of injury. These injuries conversely are often best treated with slight flexion, particularly where there is articular incongruence. All mallet injuries are often clumped together in the literature but should be clearly defined in the introduction and the inclusion criteria should be clear in this regard too.

Response 1: Thank you for your comments. Your direction is much appreciated.
The following updates have been made to the text:
Mallet finger is a common finger injury. It occurs when the distal interphalangeal joint (DIPj) is unable to extend, usually following trauma to the distal phalynx. In soft tissue mallet injuries, the tendon is partially torn or experiences a complete rupture, usually following a low energy trauma. Bony mallet injuries, whereby a large proportion of the articular surface is involved, is associated with extension of the distal joint, following a greater force of injury.

Comment 2: Participants – soft tissue and/or bony and/or hyperextension injuries (see above)?

Response 2: Based on your suggestion, this text has been updated to: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.

Comment 3: Why has September 2023 been chosen as an end date to the searches?

Response 3: The plan for the search strategy was based on academic needs.

Comment 4: Can the authors be more specific around their searching of the “grey literature"? It is also odd that only “full-text” articles are being included, but grey literature is being included. The 2 statements seem at odds with one another.

Response 4: Gray literature will be removed from the inclusion criteria.

Comment 5: Has chronicity of mallet finger been considered in the inclusion criteria?

Response 5: This is a helpful suggestion. Both acute and chronic mallet injuries will be included in the criteria.

Comment 6: Why have non-English articles been excluded? This potentially adds a selection bias.

Response 6: Resource constraints within the research team preclude us from translating any literature outside of English.

Comment 7: I worry that the search will yield no usable outcomes data and simply demonstrate what we almost certainly know already – that there is an almost complete lack of literature around 3D printing of mallet splints. A quick search using the search strategy – which seems to be somewhat restrictive – shows only 2 relevant articles.

Response 7: This is a reasonable suggestion, thank you. As this work is contributing toward a PhD for the author, it was deemed important to take the opportunity to delve into any literature related to mallet injury and 3D printing, to give a thorough analysis on which to base the future studies on.

Comment 8: Why was mallet finger chosen specifically for this review?

Response 8: This study contributed towards a PhD for the author, and their area of focus in 3D printing and mallet injuries.

Comment 9: Perhaps a more useful review could be “3D printing splints for the treatment of closed digital tendon injuries” which could include mallets and Boutonniere’s; or an even wider scope to include open tendon injuries?

Response 9: This is a reasonable suggestion. The language in participants has been updated to better explain the scope of the inclusion: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.
Comment 1: In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely very similar injuries in terms of mechanism and outcome – true hyperflexion injuries and usually relatively low energy trauma.

So-called bony mallet fractures, particularly those involving a larger proportion of the articular surface are much more likely to be an alternative mechanism – axial loading associated with EXTENSION of the distal joint – with a greater force of injury. These injuries conversely are often best treated with slight flexion, particularly where there is articular incongruence. All mallet injuries are often clumped together in the literature but should be clearly defined in the introduction and the inclusion criteria should be clear in this regard too.

Response 1: Thank you for your comments. Your direction is much appreciated.
The following updates have been made to the text:
Mallet finger is a common finger injury. It occurs when the distal interphalangeal joint (DIPj) is unable to extend, usually following trauma to the distal phalynx. In soft tissue mallet injuries, the tendon is partially torn or experiences a complete rupture, usually following a low energy trauma. Bony mallet injuries, whereby a large proportion of the articular surface is involved, is associated with extension of the distal joint, following a greater force of injury.

Comment 2: Participants – soft tissue and/or bony and/or hyperextension injuries (see above)?

Response 2: Based on your suggestion, this text has been updated to: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.

Comment 3: Why has September 2023 been chosen as an end date to the searches?

Response 3: The plan for the search strategy was based on academic needs.

Comment 4: Can the authors be more specific around their searching of the “grey literature"? It is also odd that only “full-text” articles are being included, but grey literature is being included. The 2 statements seem at odds with one another.

Response 4: Gray literature will be removed from the inclusion criteria.

Comment 5: Has chronicity of mallet finger been considered in the inclusion criteria?

Response 5: This is a helpful suggestion. Both acute and chronic mallet injuries will be included in the criteria.

Comment 6: Why have non-English articles been excluded? This potentially adds a selection bias.

Response 6: Resource constraints within the research team preclude us from translating any literature outside of English.

Comment 7: I worry that the search will yield no usable outcomes data and simply demonstrate what we almost certainly know already – that there is an almost complete lack of literature around 3D printing of mallet splints. A quick search using the search strategy – which seems to be somewhat restrictive – shows only 2 relevant articles.

Response 7: This is a reasonable suggestion, thank you. As this work is contributing toward a PhD for the author, it was deemed important to take the opportunity to delve into any literature related to mallet injury and 3D printing, to give a thorough analysis on which to base the future studies on.

Comment 8: Why was mallet finger chosen specifically for this review?

Response 8: This study contributed towards a PhD for the author, and their area of focus in 3D printing and mallet injuries.

Comment 9: Perhaps a more useful review could be “3D printing splints for the treatment of closed digital tendon injuries” which could include mallets and Boutonniere’s; or an even wider scope to include open tendon injuries?

Response 9: This is a reasonable suggestion. The language in participants has been updated to better explain the scope of the inclusion: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.
Competing Interests: No competing interests were disclosed. Close
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Author Response 16 Aug 2024

Leonard OSullivan, Rapid Innovation Unit, Confirm Centre for Smart Manufacturing, University of Limerick, Limerick, Ireland

16 Aug 2024

Author Response

Comment 1: In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely ... Continue reading Comment 1: In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely very similar injuries in terms of mechanism and outcome – true hyperflexion injuries and usually relatively low energy trauma.

So-called bony mallet fractures, particularly those involving a larger proportion of the articular surface are much more likely to be an alternative mechanism – axial loading associated with EXTENSION of the distal joint – with a greater force of injury. These injuries conversely are often best treated with slight flexion, particularly where there is articular incongruence. All mallet injuries are often clumped together in the literature but should be clearly defined in the introduction and the inclusion criteria should be clear in this regard too.

Response 1: Thank you for your comments. Your direction is much appreciated.
The following updates have been made to the text:
Mallet finger is a common finger injury. It occurs when the distal interphalangeal joint (DIPj) is unable to extend, usually following trauma to the distal phalynx. In soft tissue mallet injuries, the tendon is partially torn or experiences a complete rupture, usually following a low energy trauma. Bony mallet injuries, whereby a large proportion of the articular surface is involved, is associated with extension of the distal joint, following a greater force of injury.

Comment 2: Participants – soft tissue and/or bony and/or hyperextension injuries (see above)?

Response 2: Based on your suggestion, this text has been updated to: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.

Comment 3: Why has September 2023 been chosen as an end date to the searches?

Response 3: The plan for the search strategy was based on academic needs.

Comment 4: Can the authors be more specific around their searching of the “grey literature"? It is also odd that only “full-text” articles are being included, but grey literature is being included. The 2 statements seem at odds with one another.

Response 4: Gray literature will be removed from the inclusion criteria.

Comment 5: Has chronicity of mallet finger been considered in the inclusion criteria?

Response 5: This is a helpful suggestion. Both acute and chronic mallet injuries will be included in the criteria.

Comment 6: Why have non-English articles been excluded? This potentially adds a selection bias.

Response 6: Resource constraints within the research team preclude us from translating any literature outside of English.

Comment 7: I worry that the search will yield no usable outcomes data and simply demonstrate what we almost certainly know already – that there is an almost complete lack of literature around 3D printing of mallet splints. A quick search using the search strategy – which seems to be somewhat restrictive – shows only 2 relevant articles.

Response 7: This is a reasonable suggestion, thank you. As this work is contributing toward a PhD for the author, it was deemed important to take the opportunity to delve into any literature related to mallet injury and 3D printing, to give a thorough analysis on which to base the future studies on.

Comment 8: Why was mallet finger chosen specifically for this review?

Response 8: This study contributed towards a PhD for the author, and their area of focus in 3D printing and mallet injuries.

Comment 9: Perhaps a more useful review could be “3D printing splints for the treatment of closed digital tendon injuries” which could include mallets and Boutonniere’s; or an even wider scope to include open tendon injuries?

Response 9: This is a reasonable suggestion. The language in participants has been updated to better explain the scope of the inclusion: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.
Comment 1: In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely very similar injuries in terms of mechanism and outcome – true hyperflexion injuries and usually relatively low energy trauma.

So-called bony mallet fractures, particularly those involving a larger proportion of the articular surface are much more likely to be an alternative mechanism – axial loading associated with EXTENSION of the distal joint – with a greater force of injury. These injuries conversely are often best treated with slight flexion, particularly where there is articular incongruence. All mallet injuries are often clumped together in the literature but should be clearly defined in the introduction and the inclusion criteria should be clear in this regard too.

Response 1: Thank you for your comments. Your direction is much appreciated.
The following updates have been made to the text:
Mallet finger is a common finger injury. It occurs when the distal interphalangeal joint (DIPj) is unable to extend, usually following trauma to the distal phalynx. In soft tissue mallet injuries, the tendon is partially torn or experiences a complete rupture, usually following a low energy trauma. Bony mallet injuries, whereby a large proportion of the articular surface is involved, is associated with extension of the distal joint, following a greater force of injury.

Comment 2: Participants – soft tissue and/or bony and/or hyperextension injuries (see above)?

Response 2: Based on your suggestion, this text has been updated to: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.

Comment 3: Why has September 2023 been chosen as an end date to the searches?

Response 3: The plan for the search strategy was based on academic needs.

Comment 4: Can the authors be more specific around their searching of the “grey literature"? It is also odd that only “full-text” articles are being included, but grey literature is being included. The 2 statements seem at odds with one another.

Response 4: Gray literature will be removed from the inclusion criteria.

Comment 5: Has chronicity of mallet finger been considered in the inclusion criteria?

Response 5: This is a helpful suggestion. Both acute and chronic mallet injuries will be included in the criteria.

Comment 6: Why have non-English articles been excluded? This potentially adds a selection bias.

Response 6: Resource constraints within the research team preclude us from translating any literature outside of English.

Comment 7: I worry that the search will yield no usable outcomes data and simply demonstrate what we almost certainly know already – that there is an almost complete lack of literature around 3D printing of mallet splints. A quick search using the search strategy – which seems to be somewhat restrictive – shows only 2 relevant articles.

Response 7: This is a reasonable suggestion, thank you. As this work is contributing toward a PhD for the author, it was deemed important to take the opportunity to delve into any literature related to mallet injury and 3D printing, to give a thorough analysis on which to base the future studies on.

Comment 8: Why was mallet finger chosen specifically for this review?

Response 8: This study contributed towards a PhD for the author, and their area of focus in 3D printing and mallet injuries.

Comment 9: Perhaps a more useful review could be “3D printing splints for the treatment of closed digital tendon injuries” which could include mallets and Boutonniere’s; or an even wider scope to include open tendon injuries?

Response 9: This is a reasonable suggestion. The language in participants has been updated to better explain the scope of the inclusion: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.
Competing Interests: No competing interests were disclosed. Close
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Version 2

VERSION 2 PUBLISHED 24 Apr 2024

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	1	2
Version 2 (revision) 16 Aug 24	read	read
Version 1 24 Apr 24	read

Ryan Trickett, University Hospital of Wales, Cardiff, UK
Yutaro Kuwahara, Toyohashi Municipal Hospital, Aichi, Japan

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20 Sep 2024 | for Version 2

Yutaro Kuwahara, Toyohashi Municipal Hospital, Aichi, Japan

14 Views Cite this report Responses(0)

Approved

Dear Author

I am honored to have the opportunity to review this protocol study. As with your opinions, I basically prefer to surgical procedures such as pinning and pull-out methods due to the lack of suitable splints and the lack of access to 3D printers at my place. I consider that the methodology and clinical questions of this study are adequately described, so I consider it “Accepted”. I would like to make a few minor modifications and suggestions below.

Introduction
“They found custom splinting resulted in less skin complications as compared with custom-made splints. “
Do you mean custom-made splints resulted in less skin complications compared with ready-made splints?

Data extraction
Although it may be included in the endpoints, it is more interesting to analyze data on postoperative range of motion and recurrence rate.

I would like to thank you again for giving me this valuable chance.
Sincerely,

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Orthopaedic surgery, Hand surgery, Trauma surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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5 Views

30 Aug 2024 | for Version 2

Ryan Trickett, University Hospital of Wales, Cardiff, UK

5 Views Cite this report Responses(0)

Approved

The authors have acknowledged my queries and responded. I still consider that the protocol as described is narrow in scope, but will provide decisive answers concerning this somewhat niche field.

I also acknowledge that there are as yet no results or conclusions to comment on in this report.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Hand trauma and surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

16 Views

11 Jul 2024 | for Version 1

Ryan Trickett, University Hospital of Wales, Cardiff, UK

16 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Hand trauma and surgery

Respond to this report

Responses (1)

Author Response

16 Aug 2024

Leonard OSullivan, Rapid Innovation Unit, Confirm Centre for Smart Manufacturing, University of Limerick, Limerick, Ireland

Comment 1: In the introduction the authors discuss mallet finger and avulsion fractures. It is important to be clear that soft tissue mallet fingers and TRUE avulsion fractures are likely very similar injuries in terms of mechanism and outcome – true hyperflexion injuries and usually relatively low energy trauma.

So-called bony mallet fractures, particularly those involving a larger proportion of the articular surface are much more likely to be an alternative mechanism – axial loading associated with EXTENSION of the distal joint – with a greater force of injury. These injuries conversely are often best treated with slight flexion, particularly where there is articular incongruence. All mallet injuries are often clumped together in the literature but should be clearly defined in the introduction and the inclusion criteria should be clear in this regard too.

Response 1: Thank you for your comments. Your direction is much appreciated.
The following updates have been made to the text:
Mallet finger is a common finger injury. It occurs when the distal interphalangeal joint (DIPj) is unable to extend, usually following trauma to the distal phalynx. In soft tissue mallet injuries, the tendon is partially torn or experiences a complete rupture, usually following a low energy trauma. Bony mallet injuries, whereby a large proportion of the articular surface is involved, is associated with extension of the distal joint, following a greater force of injury.

Comment 2: Participants – soft tissue and/or bony and/or hyperextension injuries (see above)?

Response 2: Based on your suggestion, this text has been updated to: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.

Comment 3: Why has September 2023 been chosen as an end date to the searches?

Response 3: The plan for the search strategy was based on academic needs.

Comment 4: Can the authors be more specific around their searching of the “grey literature"? It is also odd that only “full-text” articles are being included, but grey literature is being included. The 2 statements seem at odds with one another.

Response 4: Gray literature will be removed from the inclusion criteria.

Comment 5: Has chronicity of mallet finger been considered in the inclusion criteria?

Response 5: This is a helpful suggestion. Both acute and chronic mallet injuries will be included in the criteria.

Comment 6: Why have non-English articles been excluded? This potentially adds a selection bias.

Response 6: Resource constraints within the research team preclude us from translating any literature outside of English.

Comment 7: I worry that the search will yield no usable outcomes data and simply demonstrate what we almost certainly know already – that there is an almost complete lack of literature around 3D printing of mallet splints. A quick search using the search strategy – which seems to be somewhat restrictive – shows only 2 relevant articles.

Response 7: This is a reasonable suggestion, thank you. As this work is contributing toward a PhD for the author, it was deemed important to take the opportunity to delve into any literature related to mallet injury and 3D printing, to give a thorough analysis on which to base the future studies on.

Comment 8: Why was mallet finger chosen specifically for this review?

Response 8: This study contributed towards a PhD for the author, and their area of focus in 3D printing and mallet injuries.

Comment 9: Perhaps a more useful review could be “3D printing splints for the treatment of closed digital tendon injuries” which could include mallets and Boutonniere’s; or an even wider scope to include open tendon injuries?

Response 9: This is a reasonable suggestion. The language in participants has been updated to better explain the scope of the inclusion: Participants: Eligible studies will include participants of any age with soft tissue and/or bony and/or hyperextension mallet injury due to trauma.

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Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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What is known from the existing literature about the treatment of Mallet Injury using 3D printed splints? A Scoping Review Protocol

Abstract

Background

Objective

Methods

Registration

Keywords

Introduction

Aim and review question

Participants

Concept

Context

Eligibility criteria

Types of sources

Methods

Search strategy

Table 1. Proposed search strategy.

Study/source of evidence selection

Data extraction

Table 2. Adapted data charting form from Joanna Briggs Institute (JBI) methodology for scoping reviews¹⁶.

Data analysis and presentation

Data availability

References

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Are you a HRB-funded researcher?

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What is known from the existing literature about the treatment of Mallet Injury using 3D printed splints? A Scoping Review Protocol

Abstract

Background

Objective

Methods

Registration

Keywords

Introduction

Aim and review question

Participants

Concept

Context

Eligibility criteria

Types of sources

Methods

Search strategy

Table 1. Proposed search strategy.

Study/source of evidence selection

Data extraction

Table 2. Adapted data charting form from Joanna Briggs Institute (JBI) methodology for scoping reviews16.

Data analysis and presentation

Data availability

References

Comments on this article Comments (0)

Open Peer Review

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Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

Stay Updated

Are you a HRB-funded researcher?

Thank you!

Table 2. Adapted data charting form from Joanna Briggs Institute (JBI) methodology for scoping reviews¹⁶.