Ergebnisse der konservativen Therapie beim frischen und alten ligamentären Mallet-Finger

[Temporarily Transfixation of the distal interphalangeal Joint in Mallet fingers]

PURPOSE

This retrospective, unicenter cohort study analyse the clinical and subjective results following temporarily K-wire transfixation of the distal interphalangeal joint (DIPJ) in hyperextension in Mallet fingers.

PATIENTS AND METHODS

By means of a self-designed questionnaire demographic data, patient´s satisfaction (0 = unsatisfied, 10 = very satisfied), persisting pain (yes/no), postoperative complications, and the Quick-DASH score were evaluated. In addition, range of motion of the DIPJ was measured with use of a self-designed template for self-evaluation by the patients. Questionnaire and template were send to 132 patients in whom a Mallet finger was treated between January 2009 and December 2019 with K-wire transfixation of the DIPJ. 65 (49,2 %) questionnaires and templates from 40 men and 25 women with an average age of 53.3 years returned. There were 40 acute and 25 chronic Mallet fingers in 35 (54 %) middle, 19 (29 %) small, 10 (15 %) ring, and 1 (2 %) index fingers. The extension deficit was classified according to Crawford.

RESULTS

According to the Crawford classification, there were 75 % excellent, 14 % good, and 11 % satisfied results. With an average of 7,9 points the patients were very satisfied. 15 patients reported about complications with six complaining persisting pain. The Quick-DASH score averaged 5.4 points.

CONCLUSION

The treatment of Mallet fingers by transfixation of the DIPJ using a K-wire is an appropriate method leading to a good.

When should splint treatment start for a tendinous mallet finger? A retrospective review of 319 fingers

In a 5-year retrospective review of 319 tendinous mallet fingers, we focused on the result after splint treatment. The splint we used was a 'no pressure' thermoformed customized Stack splint. The patients wore it strictly for 8 weeks. Based on the Patel criteria, we obtained 91% good or excellent results and 9% fair or poor results. The rate of excellent results increased significantly (p < 0.001) when treatment started 20 days after the trauma. Patients were 13 times more likely to have good or excellent results with a delayed treatment. We noticed that inflammation in the distal interphalangeal joint seemed to be detrimental to the healing process. We suggest assessing if there is inflammation to anticipate the failure of treatment, which will lead to a longer treatment. Further studies on the subject should confirm this.

[Operative treatment of osseous pull out of the extensor tendon using a hook plate]

OBJECTIVE

Anatomical reposition and stabilization of dorsal distal phalanx fractures with a hook plate.

INDICATIONS

Dislocated mallet fractures type Doyle IVb with dislocation of the fragment by more than 2 mm and/or tilting of the fragment as well as dislocation of the dorsal distal phalanx fractures type Doyle IVc.

CONTRAINDICATIONS

Florid inflammation of and injuries to the soft tissues in the operation area.

SURGICAL TECHNIQUE

Dorsal approach to the distal interphalangeal joint (Y-, S-, H-shaped). Preparation of the fragment, cleaning the fracture gap, repositioning of the fragment, mounting of the plate, placing the screw. Controlling by image converter. Suture of the skin; tape.

POSTOPERATIVE MANAGEMENT

Stack splint for 4 weeks. After week 3, start with exercising of the distal interphalangeal joint within the splint. Physiotherapy is usually not required. Full exertion after 6-8 weeks is possible. The period of inability to work is dependent on the patient's occupation. Due to the danger of perforation and infection, it is recommended that the plate be removed after 3-6 months.

RESULTS

From February 2002 to September 2009, 77 mallet fractures type Doyle IVb and IVc were operatively stabilized with a hook plate. In a retrospective study, 59 patients were followed up at a mean interval of 38.3 (3-69) months after the operation. Wound healing problems or inflammation were not observed. Visible disturbances of nail growth were macroscopically seen in 11.9%. Results were very good in 35 patients (59.3%), good in 16 patients (27.1%), sufficient in 5 patients (8.5%), satisfying in 1 patient (1.7%), and insufficient in 2 patients (3.4%).