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Lee S, Eun S. The Direct Tendon Suture and Paratenon Repair Technique for Acute Tendinous Mallet Finger: A Case Series. J Clin Med 2024; 13:3215. [PMID: 38892927 PMCID: PMC11172631 DOI: 10.3390/jcm13113215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Introduction: Tendinous mallet finger is a frequent deformity that occurs after an extensor tendon injury during sports or daily life activities. Despite the existence of numerous non-operative and operative techniques to address this deformity, there is a controversy on its optimal management. In this study, we aimed to present a direct tendon suture technique using the distal interphalangeal (DIP) joint open approach for treating tendinous mallet finger injury. (2) Methods: Between 2019 and 2021, 19 patients with closed non-fracture tendinous mallet fingers underwent the direct tendon and paratenon repair technique. After skin incision, we opened the paratenon with lazy S shape incision and found the ruptured proximal and distal tendon ends. We reapproximated the tendons using a simple interrupted suture with Prolene #6/0. After that, we meticulously performed paratenon repair using PDS #6/0 for preventing readherence. Temporary trans-articular Kirschner wire fixation was used for 4 weeks. (3) Results: All patients were followed-up for 3-8 months (mean: 4.8 months). The mean final extension lag was 6.5 degrees, and the overall rate of cases with excellent and good outcomes using Crawford's criteria was 85%. (4) Conclusions: In conclusion, this surgical approach could be a reliable alternative for the treatment of tendinous mallet finger injuries.
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Affiliation(s)
| | - Seokchan Eun
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
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Zhang Y, Gu Y, Zhou J, Zhao J, Jiang B. Direct fixation of fracture fragment with modified double Kirschner wires for the treatment of old bony mallet finger. J Plast Surg Hand Surg 2023; 58:119-123. [PMID: 37787403 DOI: 10.2340/jphs.v58.18306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The management of old bony mallet fingers is complicated. The purpose of this study was to describe direct fixation of fracture fragment with modified double Kirschner wires (K-wires) for treatment of old bony mallet finger, and to evaluate the functional outcomes during long-term follow-up. METHODS Forty-nine patients with old bony mallet finger were enrolled and underwent surgical treatment from August 2014 to January 2021 in our hospital. Patients were divided into two groups according to whether they had undergone triple K-wires fixation or modified double K-wires with a dorsal brace fixation. The operation time, mean number of intraoperative fluoroscopy, bone union time, functional recovery and incidence of complications were monitored. RESULTS Neither QuickDASH nor visual analogue scale measurement found statistically significant difference between the two groups (P > 0.05). However, the patients that underwent fixation with double K-wires and a dorsal brace required a shorter operation time and fewer intraoperative fluoroscopy, and exhibited a significantly greater mean final active range of the distal interphalangeal joint flexion, compared to those treated with triple K-wires (P < 0.01). CONCLUSION Direct fixation of fracture fragment with modified double K-wires was an easy and feasible procedure which could achieve anatomical reduction and stable fixation of the dorsal fracture block of old bony mallet finger with relatively few complications.
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Affiliation(s)
- Yong Zhang
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yingluo Gu
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jupu Zhou
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jiaju Zhao
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bo Jiang
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, Jiangsu, China.
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Aydin M, Surucu S, Capkin S, Atlihan D. Comparison of extension block pinning technique versus pin orthosis-extension block pinning technique for acute mallet fractures: a prospective randomized clinical trial. Arch Orthop Trauma Surg 2022; 142:1301-1308. [PMID: 35041082 DOI: 10.1007/s00402-022-04348-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The extension block pinning technique (EBPT) is a popular surgical treatment for mallet fractures; however, it has several drawbacks. The purpose of this randomized clinical trial was to compare EBPT to the pin orthosis-extension block pinning method (PO-EBPT) in the treatment of mallet fractures involving more than one-third of the joint surface but without primary joint dislocation. MATERIALS AND METHODS Sixty-five patients with mallet fractures were randomized into two groups between June 2017 and January 2020: Group I (33 patients) was treated with EBPT and group II (32 patients) was treated with PO-EBPT. Five patients were lost to follow up due to lack of follow-up and death. There were no significant differences in the clinical and demographic characteristics of both groups. Patients were evaluated according to fracture union, extension lag, distal interphalangeal (DIP) joint range of motion, Crawford's criteria, and complication rates. The patients were followed-up post-operatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. RESULTS A total of 60 patients were randomized into two groups: one (30 patients) was treated with EBPT and the second (30 patients) with PO-EBPT. There were no significant differences between the two groups in terms of fracture union and active DIP joint flexion (P = 0.743 and P = 0.059, respectively). The mean extension lag of the DIP joint in the EBPT group was significantly greater than the PO-EBPT group (10° ± 9.47° vs. 4.17° ± 7.2°, P = 0.009). According to the Crawford criteria, the PO-EBPT group showed significantly better outcomes (P = 0.005). The complication rates were similar between groups (P = 0.45). CONCLUSION In comparison to the EBPT technique, the group of patients operated with PO-EBPT had superior clinical outcomes and less loss of extension at the DIP joint according to the Crawford's criteria.
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Affiliation(s)
- Mahmud Aydin
- Haseki Education Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No: 7 Sultangazi, Istanbul, Turkey.
| | - Serkan Surucu
- Department of Orthopaedic Surgery, University of Missouri Kansas City, Kansas City, MO, 64108, USA
| | - Sercan Capkin
- Aksaray University Education Research Hospital, Yeni Sanayi Mah, Tacin Cd., Aksaray Merkez, 68200, Aksaray, Turkey
| | - Dogan Atlihan
- Haseki Education Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No: 7 Sultangazi, Istanbul, Turkey
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Kastenberger T, Kaiser P, Benedikt S, Stock K, Eigl M, Schmidle G, Arora R. Surgical treatment of the bony mallet thumb: a case series and literature review. Arch Orthop Trauma Surg 2022; 142:887-900. [PMID: 35032189 PMCID: PMC8994723 DOI: 10.1007/s00402-021-04333-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/25/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method. PATIENTS AND METHODS All patients (n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb (n = 21 articles). RESULTS Surgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. An open reduction led to worse functional scores compared to a closed reduction. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods. CONCLUSION The evidence for the best treatment of a bony mallet thumb fracture is low. On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.
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Affiliation(s)
- Tobias Kastenberger
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Kaiser
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Stefan Benedikt
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Kerstin Stock
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Magdalena Eigl
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Schmidle
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Yıldırım T, Güntürk ÖB, Kayalar M, Özaksar K, Sügün TS, Ademoğlu Y. The results of delayed open reduction and internal fixation in chronic bony mallet finger injuries. Jt Dis Relat Surg 2021; 32:625-632. [PMID: 34842094 PMCID: PMC8650651 DOI: 10.52312/jdrs.2021.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/11/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the functional results of delayed open reduction and Kirschner wire (K-wire) fixation procedures in patients with delayed presentation of bony mallet finger. PATIENTS AND METHODS Between February 2009 and November 2019, a total of 19 patients (15 males, 4 females; median age: 24.8 years; range, 14 to 47 years) who were diagnosed with a delayed bony mallet finger and treated with dorsal block pin, direct pinning, or the umbrella handle technique were retrospectively analyzed. The Crawford criteria were used to evaluate the outcomes. The degrees of range of motion (ROM) were measured by a goniometer. RESULTS The median time from injury to surgery was 41 (range, 28 to 90) days. The median DIP joint extension limitation was 7.63 (range, 0 to 40) degrees and the median ROM of the DIP joint was 66.3 (range, 20 to 90) degrees. There was no statistically significant difference in the postoperative ROM, compared to the uninjured side (p>0.05). The Crawford score was excellent in 11, good in four, fair in three, and poor in one patient. Bone union was achieved in all patients. CONCLUSION Delayed open reduction and K-wire fixation of chronic bony mallet finger injuries yield successful functional outcomes with low complication rates. Extension lag can be eliminated in most patients by making the joint surface anatomical. The most optimal method should be selected depending on the size of the fracture fragment.
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Affiliation(s)
- Tuğrul Yıldırım
- EMOT Hastanesi, Ortopedi ve Travmatoloji Bölümü, 35230 Konak, İzmir, Türkiye.
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Ozgozen L, Uluyardimci E. A Novel Hook Wire Tension Technique for the Treatment of Mallet Fractures: A Comparison with the Extension Block Pinning Technique. J Plast Reconstr Aesthet Surg 2021; 74:2712-2718. [PMID: 33965344 DOI: 10.1016/j.bjps.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/09/2021] [Accepted: 03/11/2021] [Indexed: 11/15/2022]
Abstract
We developed a percutaneous surgical technique that allows early mobilization and compression for the treatment of mallet fractures. The aim of this study was to describe this novel technique called the hook wire tension technique (HWTT) and provide a clinical and radiological comparison between HWTT and the extension block pinning technique (EBT) in the treatment of mallet fractures. This retrospective study included 23 mallet fracture patients treated using HWTT and 25 patients treated using EBT. At the final follow-up visit, extension lag and flexion of the distal interphalangeal joint (DIPJ) were measured. DIPJ pain was assessed by the visual analogue scale (VAS) score, and the overall clinical outcomes were graded according to the Crawford criteria. Time to bone healing and osteoarthritis development were assessed radiologically. Complications, including skin necrosis, dorsal prominence and nail deformity, were also compared. The mean follow-up period was 18 months (range: 12-24) in the HWTT group and 19.2 months (range: 12-26) in the EBT group (p = 0.239). There was no statistically significant difference between the two groups in terms of mean extension lag of the DIPJ, mean VAS scores and mean time to bone healing (p > 0.405). The mean DIPJ flexion was greater in the HWTT group compared with the EBT group (p = 0.001). According to the Crawford criteria, outcomes were similar in both groups (p = 0.370). No statistically significant difference was found between the two groups when each complication was compared (p > 0.358). The short-term clinical and functional results of HWTT were found to be similar to those of EBT in the surgical treatment of mallet fractures.
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Affiliation(s)
- Levent Ozgozen
- Iskenderun State Hospital, Department of Orthopaedics and Traumatology, Dumlupinar Mahallesi, Ulucami Cd. No: 264, 31200 Iskenderun, Hatay, Turkey.
| | - Enes Uluyardimci
- Develi Hatice-Muammer Kocaturk State Hospital, Department of Orthopaedics and Traumatology, Camiicedit Mahallesi, Hastane Cd. No: 14, 38400 Develi, Kayseri, Turkey.
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Garg BK, Rajput SS, Purushottam GI, Jadhav KB, Chobing H. Delta Wiring Technique to Treat Bony Mallet Finger: No Need of Transfixation Pin. Tech Hand Up Extrem Surg 2020; 24:131-134. [PMID: 32118869 DOI: 10.1097/bth.0000000000000281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in mallet fractures with fracture fragment involving more than one-third of the distal phalanx articular surface. The authors are reporting 5 cases of mallet fractures treated with delta wiring technique with good functional and radiologic outcomes. Radiologic outcomes were evaluated on the basis of postoperative and follow-up x-rays and functional outcomes were evaluated using Crawford's criteria. Five patients (4 males, 1 female) with a mean age of 26.8 years (range, 20 to 33 y) were included. The mean time between the injury and surgery was 5 days (range, 3 to 7 d), and the mean follow-up period was 8.6 months (range, 8 to 10 mo). Radiographic bone union was achieved in all patients within an average of 6.4 weeks (range, 6 to 7 wk). At the final follow-up, the distal interphalangeal joint had an average degree of flexion of 73 degrees (range, 70 to 75 degrees) and an average extension deficit of 5.40 (range, 0 to 8 degrees). According to Crawford's criteria, 1 patient had excellent results and 4 patients had good results. No patient reported pain at the final follow-up with a visual analog scale score mean of 0.6 (range, 0 to 2). Satisfactory clinical and radiologic outcomes were obtained with the delta wiring technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.
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Affiliation(s)
- Bipul K Garg
- Sir J.J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
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Thillemann JK, Thillemann TM, Kristensen PK, Foldager-Jensen AD, Munk B. Splinting versus extension-block pinning of bony mallet finger: a randomized clinical trial. J Hand Surg Eur Vol 2020; 45:574-581. [PMID: 32338190 DOI: 10.1177/1753193420917567] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical treatment of bony mallet fingers is frequently recommended, but the evidence is sparse. This randomized clinical trial aimed to compare nonoperative splinting versus extension-block pinning of bony mallet fingers with involvement of more than one-third of the joint surface but without primary joint subluxation. Thirty-two patients were randomized and 28 fulfilled the protocol. At 6 months follow-up, there were no significant differences in active extension lag in the distal interphalangeal joint (the primary outcome) or in patient-reported function and pain scores. Flexion and active range of motion in the distal interphalangeal joint and finger-to-palm distance were better in the splinting group, but three patients developed secondary subluxation. We conclude from this study, that splinting these injuries is safe and efficient in restoring joint motion, but splinting does not sufficiently prevent secondary subluxation of the joint. Radiographic follow-up during splinting appears to be necessary. Level of evidence: I.
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Affiliation(s)
- Janni K Thillemann
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark
| | | | - Pia K Kristensen
- Department of Orthopaedic Surgery, Regional Hospital Horsens, Horsens, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bo Munk
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Schwendinger P, Horling L, Schmolz W, Hörmann R, Arora R. Mallet finger - A modified technique using the finger nail as a fixation point for the temporary immobilization of the distal interphalangeal joint - A biomechanical study. Clin Biomech (Bristol, Avon) 2019; 69:64-70. [PMID: 31302491 DOI: 10.1016/j.clinbiomech.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/12/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the current biomechanical study was to investigate a newly developed surgical technique for mallet fingers. The new method is based on the Ishiguro method which requires a K-wire through the distal interphalangeal joint for temporary fixation. The new technique avoids the joint trans fixation using a specially designed finger nail holder. This method was compared to the established Ishiguro's technique. METHODS For biomechanical testing, 32 paired, fresh-frozen human fingers (Digit II-V) of 4 donors (ages 60 to 71 years) were used. The paired fingers were assigned to either the new method or Ishiguro's technique. The biomechanical testing consisted of a cyclic cantilever bending (2000 cycles, 1-7N) followed by a load to failure test. The groups were evaluated for plastic deformation, stiffness, change in stiffness during cyclic loading, subluxation and failure load by analysing force-deflect data and fluoroscopic images. FINDINGS The nail fixation group showed significantly higher failure loads and stiffness than the trans fixation group. The values of plastic deformation were significantly lower in the nail fixation group. No differences were found in the change of stiffness. No subluxation was found in both groups. INTERPRETATION In the current biomechanical study, nail fixation performed at least as good as Ishiguro's trans fixation technique. The results and ease of implementation indicate that the newly developed nail fixation technique might be a useful treatment method in daily clinical practice without the need of temporary joint trans-fixation avoiding possible associated problems. To establish this method, clinical trials will be necessary.
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Affiliation(s)
- Peter Schwendinger
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Lukas Horling
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Schmolz
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Romed Hörmann
- Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Müllerstrasse 59, 6020 Innsbruck, Austria
| | - Rohit Arora
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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Supplemental Method for Reduction of Irreducible Mallet Finger Fractures by the 2-Extension Block Technique: The Dorsal Counterforce Technique. J Hand Surg Am 2019; 44:695.e1-695.e8. [PMID: 30409505 DOI: 10.1016/j.jhsa.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/09/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE We suggest a method to achieve anatomical reduction in mallet finger fractures that are insufficiently treated by the 2-extension block wire technique. METHODS We performed a retrospective review of 18 patients who were found to have an irreducible dorsal fragment and distal interphalangeal joint incongruence owing to rotation of the dorsal fragment in the sagittal plane. In these cases, we additionally employed a dorsal counterforce technique to supplement the 2-extension block technique. An additional K-wire was used to apply counterforce against the distal part of the dorsal fragment and control rotation in the sagittal plane. RESULTS All 18 fractures united. Congruent joint surfaces and anatomical reduction were seen in all cases. The mean active flexion of the distal interphalangeal joints was 83.8° (range, 79°-88°) and the mean extension loss was 0.4° (range, 0°-4°). CONCLUSIONS We believe that the dorsal counterforce technique effectively supplements the 2-extension block K-wire technique and aids control of dorsal fragment rotation in the sagittal plane. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Garg BK, Waghmare GB, Singh S, Jadhav KB. Mallet Finger Fracture Treated with Delta Wiring Technique: A Case Report of a New Fixation Technique. J Orthop Case Rep 2019; 10:98-101. [PMID: 32547990 DOI: 10.13107/jocr.2019.v10.i01.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in a case of mallet finger with fracture fragment involving more than one-third of the distal phalanx articular surface. This is the first reported case of mallet fracture treated with delta wiring in literature. Case Report A 30-year-old male patient admitted in our institute with complaints of severe pain in the right index finger with inability to extend the distal interphalangeal joint (DIP) for 5 days. There was a history of fall from the bike before this complaint. Radiographs revealed a bony mallet fracture involving more than one-third of the articular surface of distal phalanx. The patient was taken up for delta wiring fixation of the fracture. Radiographic bony union was seen at 7 weeks. At the final follow-up at 1 year, DIP had 75° of flexion and had extension deficit of 5°. According to Crawford's criteria, the patient had good results with a VAS score of 1 with no pain. Conclusion Delta wiring technique is a new and safe treatment modality for bony mallet fracture with fracture fragment involving more than one-third of the distal phalanx articular surface as satisfactory clinical and radiological outcomes obtained in our case.
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Affiliation(s)
- Bipul K Garg
- Department of Orthopaedic Surgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Gaurav B Waghmare
- Department of Orthopaedic Surgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Shravan Singh
- Department of Orthopaedic Surgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Kishor B Jadhav
- Department of Orthopaedic Surgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
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Extension block and direct pinning methods for mallet fracture: A comparative study. Arch Plast Surg 2018; 45:351-356. [PMID: 30037196 PMCID: PMC6062697 DOI: 10.5999/aps.2017.01431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/05/2018] [Indexed: 11/24/2022] Open
Abstract
Background Mallet fracture can easily occur during sports activities or in daily life; however, the principles and methods of treatment for such fractures remain debated. Among the surgical treatments, various methods of closed reduction have been proposed. We treated patients with the extension block method (EBM) and the direct pinning method (DPM), and then compared the results. We assessed differences in range of motion and measurements of finger movement after surgery. Methods A total of 41 patients who underwent surgery from August 2013 to September 2015 were evaluated retrospectively. Among them, 21 patients were treated with the EBM and 20 patients were treated with the DPM. We then compared extensor lag, range of motion, and outcomes according to Crawford’s criteria between before surgery and at 6 to 8 months postoperatively. Results The postoperative extensor lag improvement was 4.28° and 10.73°, and the postoperative arc of motion was 55.76° and 61.17° in the EBM and DPM groups, respectively. The Crawford assessment showed no statistically significant difference between the groups, although the score in the DPM group was higher than that in the EBM group (3.5 vs. 3.1). Conclusions As closed reduction methods for the treatment of mallet fracture, both the EBM and DPM showed good results. However, the DPM proved to be superior to the EBM in that it produced greater improvements in extensor lag and range of motion.
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Vester H, Schul L, von Matthey F, Beirer M, van Griensven M, Deiler S. Patient satisfaction after hook plate treatment of bony avulsion fracture of the distal phalanges. Eur J Med Res 2018; 23:35. [PMID: 30029681 PMCID: PMC6053819 DOI: 10.1186/s40001-018-0332-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bony avulsion fractures of the distal phalanges can result in mallet finger deformity if not treated appropriately. Therefore, only minimally displaced fractures can be treated conservatively with a good outcome, as dislocation occurs very often. Several surgical treatment options have been developed during the past decades. Data concerning the recently developed hook plate are promising. So far, no data concerning the subjective satisfaction with this method have been published. Therefore, we have analyzed the outcome after hook plate implantation using a self-assessment score, which focuses also on subjective parameters and satisfaction. METHODS Standardized questionnaires (self-assessment scores and SF-36 questionnaire) were sent to each patient treated with a hook plate due to fracture of the distal phalanx, type Doyle IVb and IVc. Clinical data were evaluated according to the medical record. Scores given per question range from 0 to 10, 10 is the worst and 0 the best outcome. RESULTS From 69 patients treated, 38 (58%) were enrolled. The whole collective (n = 38) reached a score of 39.7 ± 28.7 points, while men had slightly better results. Men (n = 24) achieved 37.3 ± 27.9 points, women (n = 14) 43.9 ± 30.7 points. Women had significantly better results when analyzed later than 12 months after surgery (52.1 ± 27.9 vs. 29.1 ± 32.8), whereas no changes could be detected in the male group (37.1 ± 29.9 vs. 37.4 ± 27.6). Overall, men were slightly more satisfied than women. Most satisfaction was found regarding pain and fine motor skills (0-0.46 points). Esthetic aspect and nail deformities (3.65 points average) led to the highest dissatisfaction. No differences in the SF 36 score could be detected. CONCLUSIONS The hook plate is not only a convenient method but it also results in high patient satisfaction. Nail deformities are challenging; however, with increasing experience of the surgeon they decrease. SF 36 score is not an appropriate testing tool for this problem.
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Affiliation(s)
- H Vester
- Interdisciplinary Hand Department IHZ, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
| | - L Schul
- Interdisciplinary Hand Department IHZ, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - F von Matthey
- Interdisciplinary Hand Department IHZ, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - M Beirer
- Interdisciplinary Hand Department IHZ, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - M van Griensven
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - S Deiler
- Interdisciplinary Hand Department IHZ, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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14
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A retrospective study of closed extension block pinning for mallet fractures: Analysis of predictors of postoperative range of motion. J Plast Reconstr Aesthet Surg 2018; 71:876-882. [DOI: 10.1016/j.bjps.2018.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/31/2018] [Indexed: 11/23/2022]
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15
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Karslioglu B, Tekin AC, Tasatan E. The Weakest Point of "The Shepherd's Crook" Technique: Suture Tension. Tech Hand Up Extrem Surg 2018; 22:35. [PMID: 29360673 DOI: 10.1097/bth.0000000000000180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Bulent Karslioglu
- Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi
| | - Ali C Tekin
- Okmeydani Training and Research Hospital, İstanbul, Turkey
| | - Ersin Tasatan
- Okmeydani Training and Research Hospital, İstanbul, Turkey
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16
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Abstract
BACKGROUND A variety of surgical techniques for treating mallet fracture finger has been reported with different outcomes and complications. However, the optimal procedure remains controversial. This study describes surgical outcomes of mallet fractures of the finger with distal phalanx treated by modified pull-out wire fixation with Kirschner wire (K-wire) stabilization of the DIP joint in hyperextension. MATERIALS AND METHODS 30 patients who had mallet fracture finger injuries (Doyle's classification type IVC) with DIP joint subluxation between January 2009 and January 2015 were included in this study. The mean age was 28 years (range 18-50 years), and the mean duration of followup was 8 months (range 6-12 months). Outcome assessments included the skin necrosis, wire tract infection, bony union, and extension lag. We measured the pinch strength test at 8 weeks and 12 weeks postoperatively and graded the clinical results using Crawford's criteria. RESULTS All fractures united after surgery. There was no iatrogenic fracture fragmentation, marginal skin necrosis, wire tract infection, and nail deformity. The mean extension lag was 1.8° (range 0°-17°) through goniometer, 24 of 30 patients had 0° of extension lag. The pinch strength measured at 8 weeks and 12 weeks was 79% and improved to 91%, respectively, compared with uninjured opposite finger. According to Crawford's criteria, 24 patients were classified as excellent, 3 were good, and 3 were fair. No poor result in this study. CONCLUSION Our modified pull-out wire fixation over a button and K-wire stabilization of DIP joint in hyperextension is a reliable surgical method for treating acute mallet fracture finger and DIP joint volar subluxation.
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Affiliation(s)
- Yueh-Hsiu Lu
- Orthopaedic Surgery Department, Section of Hand Surgery, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Chia-Chieh Wu
- Orthopaedic Surgery Department, Section of Hand Surgery, Changhua Christian Hospital, Changhua, Taiwan, ROC,Orthopaedic Surgery Department, Orthopedics and Sports Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan, ROC,Institute of Biomedical Sciences, National Chung Hsing University, 145 Xingda Rd., South Dist., Taichung 40227, Taiwan,School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, ROC,Address for correspondence: Dr. Chia-Chieh Wu, Orthopaedic Surgery Department, Section of Hand Surgery, Changhua Christian Hospital, 135, Nansiao St., Changhua, Taiwan, ROC. E-mail:
| | - Chen-Pu Hsieh
- Orthopaedic Surgery Department, Section of Hand Surgery, Changhua Christian Hospital, Changhua, Taiwan, ROC,Orthopaedic Surgery Department, Orthopedics and Sports Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan, ROC
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Ota T, Itoh S, Matsuyama Y. Comparison of Treatment Results for Mallet Finger Fractures in Children Between Low-Intensity Pulsed Ultrasound Stimulation and Ishiguro's Method. Hand (N Y) 2018; 13:80-85. [PMID: 28719993 PMCID: PMC5755870 DOI: 10.1177/1558944717692095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We compared the treatment results for displaced mallet finger fractures in children between low-intensity pulsed ultrasound (LIPUS) stimulation and Ishiguro's method, which involves extension block and arthrodesis of the distal interphalangeal (DIP) joint with pinning. METHODS Eleven cases (5 females and 6 males; average age, 13.5 years) of mallet finger were operated with Ishiguro's method, and 8 cases (3 females and 5 males; average age, 13.0 years) were treated with LIPUS stimulation. Lateral radiographs were used to determine the distance of fragment displacement and the percentage of the articular surface involved in the fragments. Functional outcomes in flexion and extension and those estimated using Crawford's evaluation criteria at the final visits were assessed in each group. RESULTS The duration needed for fracture healing was longer, however, active extension and flexion of the DIP joint were significantly larger in the LIPUS group compared with those in the pinning group. Functional recovery was excellent in all cases in the LIPUS group; however, recovery was good in 3 cases and excellent in 8 cases in the pinning group. Extension of the DIP joint was significantly larger when pins were removed in 35 or lesser days postoperatively compared with cases in which pin fixation was continued for more than 35 days. CONCLUSIONS LIPUS therapy may be recommended as an option to treat type I mallet finger in children for whom initiation of treatment was delayed up to 8 weeks. When Ishiguro's method is applied to the displaced mallet fracture in children, arthrodesis of the DIP joint for more than 5 weeks should be avoided to prevent flexion contracture.
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Affiliation(s)
| | - Soichiro Itoh
- Tokyo Medical and Dental University, Japan,Soichiro Itoh, Department of Inorganic Materials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo 101-0062, Japan.
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18
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Abstract
Traditional pull-out techniques for tendon and ligament repair are still widely used in hand surgery, despite constant refinements and the development of other methods of fixation. We propose a modification of the classic technique which utilizes a K-wire as an external strut instead of the classic button. This fixation system can be usefully applied in the fixation of extensor and flexor tendons and reinsertions. It is particularly applicable in situations where a transarticular K-wire is to be used anyway, in situations of temporary joint immobilization and in other situations.
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19
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Yoon JO, Baek H, Kim JK. The Outcomes of Extension Block Pinning and Nonsurgical Management for Mallet Fracture. J Hand Surg Am 2017; 42:387.e1-387.e7. [PMID: 28274605 DOI: 10.1016/j.jhsa.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to compare the clinical and radiographic results of patients with a mallet fracture involving more than one-third of the articular surface, but without a high degree of distal interphalangeal (DIP) joint subluxation, treated with extension block pinning or nonsurgical management. METHODS Forty-nine patients with a mallet fracture involving more than one-third of the articular surface were reviewed. Twenty-six cases were treated using extension block pinning (surgery group) and 23 were treated nonsurgically (nonsurgical group). At the final follow-up, extension lag and flexion of the DIP joint of the affected digit were measured. Distal interphalangeal joint pain was rated using a visual analog scale and the overall clinical outcomes were graded using Crawford's criteria. Complications, including nail deformity and dorsal prominence, were also assessed. The rate of DIP joint subluxation and fracture fragment size were radiographically evaluated. RESULTS Mean extension lag and flexion of the DIP joint and mean visual analog pain scores were not significantly different in the 2 groups. Outcomes, as assessed using Crawford's criteria, were excellent in 5, good in 12, fair in 6, and poor in 3 in the surgery group, and excellent in 2, good in 11, fair in 8, and poor in 2 in the nonsurgical group. Moreover, the frequency of nail deformity or dorsal prominence was similar in the 2 groups. The rate of DIP subluxation and mean fracture fragment size were similar between the 2 groups. All the fractures had united by 3 months after injury in both groups. CONCLUSIONS The clinical outcomes do not significantly differ between extension block pinning and nonsurgical management for mallet fractures involving more than one-third of the articular surface, but without high degree subluxation of the DIP joint. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jun O Yoon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyungki Baek
- Department of Orthopedic Surgery, Ewha Womans Universtiy Mokdong Hospital, Seoul, Republic of Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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20
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Moradi A, Braun Y, Oflazoglu K, Meijs T, Ring D, Chen N. Factors associated with subluxation in mallet fracture. J Hand Surg Eur Vol 2017; 42:176-181. [PMID: 27697897 DOI: 10.1177/1753193416669929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Radiographs and medical record of all adult patients with a mallet fracture in three hospitals between 2004 and 2014 were reviewed. International Classification of Diseases, Ninth Revision (ICD-9) codes and text search in radiographic reports were used to identify all acute patients with potential mallet fractures in our institutional database. Manually checking, 392 true mallet fractures were identified among them, 78 had subluxation at the time of diagnosis and 19 had subluxation at a later time point during treatment. Fragment size, fragment displacement, and interval between injury and treatment were associated with initial and late subluxation. Subluxation was not observed when the fracture size was less than 39% of the total articular surface. For each 1% increase in total articular surface involvement in fractures with more than 39% involvement, the risk of subluxation increased by 4% and for each 1% of displacement, the risk of subluxation increased by 4%. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Moradi
- 1 Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA.,2 Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Y Braun
- 1 Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - K Oflazoglu
- 1 Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - T Meijs
- 1 Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - D Ring
- 1 Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - N Chen
- 1 Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
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21
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Review of Acute Traumatic Closed Mallet Finger Injuries in Adults. Arch Plast Surg 2016; 43:134-44. [PMID: 27019806 PMCID: PMC4807168 DOI: 10.5999/aps.2016.43.2.134] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/16/2022] Open
Abstract
In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.
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22
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Zhang W, Zhang X, Zhao G, Gao S, Yu Z. Pressing fixation of mallet finger fractures with the end of a K-wire (a new fixation technique for mallet fractures). Injury 2016; 47:377-82. [PMID: 26657890 DOI: 10.1016/j.injury.2015.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/14/2015] [Accepted: 09/19/2015] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to describe and evaluate a surgical technique for the treatment of mallet finger fractures using a K-wire stabilization of the distal interphalangeal (DIP) joint and another K-wire pressing the bone fragment. METHODS Between June 2007 and March 2014, 41 patients (28 men, 13 women) with isolated closed mallet finger fracture were treated using two K-wires. In the cohort, the mean joint surface involvement was 44.3% (range: 28-62%). With a mean period of 23.6 months, patient follow-up lasted 13-34 months. The fingers were evaluated for loss of extension and flexion of the (DIP) joints. The results were graded using Crawford's criteria. RESULTS Union of all fractures took place at an average of 5.5 weeks after the surgical procedure. Average extension lag was 4°, and active flexion 71°. According to the Crawford rating scale, 35 fingers were excellent, four were good, one was fair, and one was poor. CONCLUSIONS Pressing fixation of the bone fragment with the end of a K-wire was a useful technique in the treatment of mallet finger fractures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Wenlong Zhang
- Department of Hand Surgery, Second Hospital of Tangshan, Hebei, People's Republic of China
| | - Xu Zhang
- Department of Hand Surgery, Second Hospital of Qinhuangdao, Hebei, People's Republic of China
| | - Gang Zhao
- Department of Hand Surgery, Second Hospital of Tangshan, Hebei, People's Republic of China.
| | - Shunhong Gao
- Department of Hand Surgery, Second Hospital of Tangshan, Hebei, People's Republic of China
| | - Zhiliang Yu
- Department of Hand Surgery, Second Hospital of Tangshan, Hebei, People's Republic of China
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23
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Acar MA, Güzel Y, Güleç A, Uzer G, Elmadağ M. Clinical comparison of hook plate fixation versus extension block pinning for bony mallet finger: a retrospective comparison study. J Hand Surg Eur Vol 2015; 40:832-9. [PMID: 25881978 DOI: 10.1177/1753193415581517] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/21/2015] [Indexed: 02/03/2023]
Abstract
The aim of this retrospective study was to determine whether traumatic mallet fractures had better outcomes when treated by hook plate fixation (13 patients) or extension block pinning (19 patients). We assessed outcomes using Crawford's criteria; distal interphalangeal joint range of motion; the DASH score; and a visual analogue scale score for pain. We measured radiological parameters. No significant differences were observed in functional and clinical outcomes and in complications. Whereas the operative time was longer in the hook plate group, intraoperative fluoroscopy use, time to bone union and time to return to work were greater in the extension block group. Although the hook plate method is more technically demanding, it provides good stable reduction, earlier mobilization and an earlier return to work. The extension block pinning technique is easier and as effective but it requires greater peri-operative fluoroscopy. Level of evidence: Level III.
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Affiliation(s)
- M A Acar
- Department of Orthopaedics and Traumatology, Medical School of Selcuk University, Konya, Turkey
| | - Y Güzel
- Department of Orthopaedics and Traumatology, Ordu University, Ordu
| | - A Güleç
- Department of Orthopaedics and Traumatology, Medical School of Selcuk University, Konya, Turkey
| | - G Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, Fatih, İstanbul
| | - M Elmadağ
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, Fatih, İstanbul
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24
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Zhang X, Shao X, Huang Y. Pullout wire fixation together with distal interphalangeal joint Kirschner wire stabilization for acute combined tendon and bone (double level) mallet finger injury. J Hand Surg Am 2015; 40:363-7. [PMID: 25543162 DOI: 10.1016/j.jhsa.2014.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/29/2014] [Accepted: 11/12/2014] [Indexed: 02/02/2023]
Abstract
This article describes a previously unclassified type of combined tendon/bone mallet finger. This supplements the conventional Doyle classification. The article also describes the technique for surgical treatment of such mallet fingers, which involves the use of a pullout wire with K-wire stabilization of the distal interphalangeal joint.
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Affiliation(s)
- Xu Zhang
- Hand Surgery Department, The Second Hospital of Qinhuangdao, Hebei, China; Hand Surgery Department, Third Hospital of Hebei Medical University, Hebei, China; Department of Orthopaedics, Funing Hospital, Hebei, China
| | - Xinzhong Shao
- Hand Surgery Department, The Second Hospital of Qinhuangdao, Hebei, China; Hand Surgery Department, Third Hospital of Hebei Medical University, Hebei, China; Department of Orthopaedics, Funing Hospital, Hebei, China.
| | - Yong Huang
- Hand Surgery Department, The Second Hospital of Qinhuangdao, Hebei, China; Hand Surgery Department, Third Hospital of Hebei Medical University, Hebei, China; Department of Orthopaedics, Funing Hospital, Hebei, China
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25
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Kim JK, Kim DJ. The risk factors associated with subluxation of the distal interphalangeal joint in mallet fracture. J Hand Surg Eur Vol 2015; 40:63-7. [PMID: 25336473 DOI: 10.1177/1753193414554556] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical fixation is recommended when a mallet fracture involves more than one-third of the articular surface of the distal phalanx. This recommendation originates from the idea that involvement of more than one-third of the base of the distal phalanx causes subluxation of the distal interphalangeal (DIP) joint. Eighty-six fingers of 85 patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx were enrolled in this study. Patients were allocated on the basis of subluxation of the DIP joint into a group with no subluxation or a group with subluxation. These two groups were compared with respect to age, sex, fracture size, fracture displacement, time to finger immobilizer application, and initial extensor lag of the DIP joint. Backward stepwise multiple logistic regression analysis was performed to identify the risk factors of DIP joint subluxation, and receiver operating curve analysis was used to calculate the optimal cut-off point for the risk factors. Half of our patients with a mallet fracture involving > one-third of the articular surface of the distal phalanx showed subluxation of the DIP joint. A significant intergroup difference was found for fracture size and time to application of a finger immobilizer, but no significant difference was observed for other parameters. The risk factors of DIP joint subluxation were fracture size and time to application of finger immobilizer. The optimal cut-off values for the development of DIP joint subluxation were 48% for the fracture size and 12.5 days for time to finger immobilizer application.
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Affiliation(s)
- J K Kim
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, South Korea
| | - D J Kim
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, South Korea
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26
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Abstract
One-third of all mallet fingers are associated with a fracture. Mallet fractures associated with large fracture fragments may result in volar subluxation of the distal phalanx. The management of mallet fractures varies based on injury pattern and surgeon preference. These treatment options include splinting regimens, closed reduction and percutaneous pinning and open reduction and internal fixation. Although numerous surgical techniques have been described, there is little clear consensus on operative treatment. Moreover, there is insufficient evidence to support operative over nonoperative treatment for mallet fractures.
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Affiliation(s)
- T Wada
- Department Orthopaedic Surgery, Saisei-kai Otaru Hospital, Otaru, Japan
| | - T Oda
- Department Orthopaedic Surgery, Saisei-kai Otaru Hospital, Otaru, Japan
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28
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Lee HJ, Jeon IH, Kim PT, Oh CW. Tension wire fixation for mallet fracture after extension block pinning failed. Arch Orthop Trauma Surg 2014; 134:741-6. [PMID: 24622822 DOI: 10.1007/s00402-014-1968-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Various surgical treatments such as extension block pinning have been proposed for acute bony mallet finger. We evaluated the clinical results of tension wire fixation technique for the treatment of nonunion of mallet fracture after failed mallet finger surgery. MATERIALS AND METHODS Nine male patients were treated with open tension wire fixation for chronic nonunion of mallet fracture after extension block pinning surgery failed. The mean age was 29.3 years (range 18-47). We assessed bone union in simple radiographs. Crawford's and Bischoff functional score was used to assess the functional outcome. RESULTS The mean follow-up period was 45.8 months (range 18-74). Clinical and radiographic bone unions were achieved in eight of nine patients with average time of 31 days (range 23-41). Mean extension lag at final follow-up was 7° (range 0-25). Four patients showed excellent, three patients showed good and two patients showed fair results on the Crawford's score scale. With Bischoff functional score, all patients were categorized as excellent. CONCLUSIONS Tension wire fixation can be a good second-line reconstructive surgery for the treatment of mallet fracture after extension block failed, so that patients can avoid arthrodesis or complex tendon transfer as a salvage procedure.
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Affiliation(s)
- Hyun-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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29
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Shimura H, Wakabayashi Y, Nimura A. A novel closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation for mallet fractures. J Orthop Sci 2014; 19:308-312. [PMID: 24452795 PMCID: PMC3960482 DOI: 10.1007/s00776-013-0526-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Some patients with mallet fractures who undergo extension block pinning complain of exposed wires, which delay their return to sports and causes inconvenience while performing tasks that require the use of hands during the early postoperative period. The purpose of this retrospective study was to present and evaluate a novel surgical procedure for mallet fractures. METHODS We treated 20 patients (14 males and six females; mean age, 38.4 years; range 17-68 years) with displaced mallet fractures involving >30 % of the articular surface using the closed reduction and microscrew fixation between January 2009 and January 2012. The distal interphalangeal joint (DIP) joint was immobilized with a splint for 1-3 weeks on an individual case basis. According to Wehbe and Schneider's classification, there were 12 type IB, six type IIB, and two type IA fractures. The mean follow-up duration was 12.6 months (range 6-31 months). RESULTS Bone union was achieved in all patients within a mean period of 6.8 weeks, with no incidence of infection, skin necrosis, permanent nail deformity, or secondary osteoarthritis. Only two complications-temporary nail ridging in one patient and a dorsal bump caused by the screw in one patient-were observed. Minimum postoperative displacement was observed in one patient, for whom immobilization with a splint was continued for 4 weeks. Articular incongruity was <1.0 mm in four patients and 1.0-2.0 mm in two patients. Mean DIP joint extension loss was 6.5° and mean flexion was 67.8°. The surgical outcomes were excellent in seven patients, good in nine, and fair in four according to Crawford's evaluation criteria. CONCLUSION Our novel surgical procedure combining closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation produces good clinical results with relatively few complications.
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Affiliation(s)
- Haruhiko Shimura
- Department of Orthopaedic Surgery, National Printing Bureau Tokyo Hospital, 2-3-6 Nishigahara, Kita-ku, Tokyo, 114-0024 Japan ,Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Yoshiaki Wakabayashi
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Akimoto Nimura
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
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Miura T. Extension block pinning using a small external fixator for mallet finger fractures. J Hand Surg Am 2013; 38:2348-52. [PMID: 24144614 DOI: 10.1016/j.jhsa.2013.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/31/2013] [Accepted: 09/03/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe surgical outcomes of a series of patients with bony mallet fingers treated by a modified extension blocking technique with external fixation. METHODS We developed an external fixator that was attached to the extension block pin. Dorsal rotation of the dorsal fragment during reduction was prevented with 1 or 2 additional pins abutted on the fragment through the fixator. We reviewed 12 consecutive patients with mallet finger fractures who were treated surgically with the external fixator. The mean age of the patients was 33 years (range, 15-60 y). RESULTS Rotation of the fragment during reduction was well controlled in all patients. All fractures united at an average of 5 weeks after surgery. Average extension lag was 2° and active flexion was 74°. No patient reported pain at a final follow-up of 4 months (range, 3-8 mo). According to the Crawford rating scale, 10 patients were classified as excellent and 2 were good. CONCLUSIONS Our modification of the extension block method prevented dorsal rotation of the fragment during reduction and resulted in early union. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Toshiki Miura
- Department of Orthopaedic Surgery, Graduate School of Medicine, University of Tokyo; and the Department of Orthopaedic Surgery, JR Tokyo General Hospital, Tokyo, Japan.
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Abstract
Fractures of the hand are common injuries and in particular, fractures involving the articular surfaces can present difficulties to the orthopedic surgeon in practice. Although the treatment of these fractures needs to be individualized based on fracture pattern and location, the goals for these fractures are to restore the alignment, stability, and congruity and to allow for early motion to prevent stiffness and traumatic arthritis. This article classifies the various types of intra-articular hand fractures as well as the workup and management of these injuries.
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Affiliation(s)
- Nikhil Oak
- Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, 2912 Taubman Center, Ann Arbor, MI 48109, USA
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Kang HJ, Lee SK. Open accurate reduction for irreducible mallet fractures through a new pulp traction technique with primary tendon repair. J Plast Surg Hand Surg 2012; 46:438-43. [PMID: 23157506 DOI: 10.3109/2000656x.2012.727822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sixteen patients with bony mallet fingers were treated by a new technique of open reduction through a T-shaped dorsal incision and oblique wire fixation via pulp traction with additional primary extensor repair. Surgical indications included fractures with intra-articular involvement over 1/3 of the articular surface, distal phalanx subluxation, and displacement greater than 3 mm irreducible by extension block pinning. The cases were analysed prospectively for a mean follow-up period of 12 months. The results were evaluated using Crawford's criteria. Eleven cases were evaluated as excellent, three cases as good, and two cases as fair. Complications included three cases with transient nail deformity, two cases with flexion limitation of 5° and 10°, and three cases with extension lag between 5°-10°. This new method of accurate reduction achieves good clinical outcomes, with comparatively less complications in mallet fractures irreducible to closed extension block reduction.
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Affiliation(s)
- Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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