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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 2024; 29:1091-1096. [PMID: 37550176 DOI: 10.1016/j.jos.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The aim of this study was to compare the functional outcomes and direct costs of Stack splints and aluminum finger splints when used in the conservative management of patients with acute Doyle type IVb bony mallet finger. METHODS We retrospectively analyzed demographic and clinical characteristics, functional outcomes (using the Crawford classification, DIP flexion angles, and extension lag measurements), time to confirmation of union, and splint costs of 24 patients treated with aluminum finger splints (Group 1) and 20 patients treated with Stack splints (Group 2). RESULTS Of 44 patients, the median age was 38 (range, 20-59) years, 14 (32%) were smokers, 23 (52%) had fourth digit injuries, 32 (70%) had injuries to the dominant hand, 30 (68%) had a mechanism of injury of a fall, and median follow-up was 15 (range, 12-18) months; none of these differed significantly between Group 1 and Group 2 (all p > 0.05). In Group 1, functional outcomes were excellent and good in 14 (58%) and 10 (42%) patients, respectively; in Group 2 functional outcomes were excellent and good in 13 (62%) and 7 (35%) patients, respectively; and there was no significant difference between the groups. Median extension lag was 3.2° (range, 3.0°-3.5°) in group 1 and 3.4° (range, 3.2°-3.8°) in group 2, indicating no significant difference between groups. Complete union was confirmed radiographically in all patients. Per-patient cost was significantly lower for aluminum finger splints (0.208 TRY [US $0.03]) than for Stack splints (25 TRY [US $3.60]). CONCLUSIONS Good functional outcomes are possible with the use of either Stack or aluminum finger splints in patients with acute Doyle type IVb mallet finger, confirming that conservative management may be appropriate for these injuries. Direct costs of Stack splints are many times greater than those of aluminum splints, though the costs for both are relatively low. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- Erdinc Acar
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Hand and Upper Extremity Surgery Division, Ankara, Turkey.
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Pressman SM, Borna S, Gomez-Cabello CA, Haider SA, Forte AJ. AI in Hand Surgery: Assessing Large Language Models in the Classification and Management of Hand Injuries. J Clin Med 2024; 13:2832. [PMID: 38792374 PMCID: PMC11122623 DOI: 10.3390/jcm13102832] [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: 04/11/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background: OpenAI's ChatGPT (San Francisco, CA, USA) and Google's Gemini (Mountain View, CA, USA) are two large language models that show promise in improving and expediting medical decision making in hand surgery. Evaluating the applications of these models within the field of hand surgery is warranted. This study aims to evaluate ChatGPT-4 and Gemini in classifying hand injuries and recommending treatment. Methods: Gemini and ChatGPT were given 68 fictionalized clinical vignettes of hand injuries twice. The models were asked to use a specific classification system and recommend surgical or nonsurgical treatment. Classifications were scored based on correctness. Results were analyzed using descriptive statistics, a paired two-tailed t-test, and sensitivity testing. Results: Gemini, correctly classifying 70.6% hand injuries, demonstrated superior classification ability over ChatGPT (mean score 1.46 vs. 0.87, p-value < 0.001). For management, ChatGPT demonstrated higher sensitivity in recommending surgical intervention compared to Gemini (98.0% vs. 88.8%), but lower specificity (68.4% vs. 94.7%). When compared to ChatGPT, Gemini demonstrated greater response replicability. Conclusions: Large language models like ChatGPT and Gemini show promise in assisting medical decision making, particularly in hand surgery, with Gemini generally outperforming ChatGPT. These findings emphasize the importance of considering the strengths and limitations of different models when integrating them into clinical practice.
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Affiliation(s)
| | - Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Syed Ali Haider
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
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Krastman P, de Schepper E, Bindels P, Bierma-Zeinstra S, Kraan G, Runhaar J. Incidence and management of mallet finger in Dutch primary care: a cohort study. BJGP Open 2024; 8:BJGPO.2023.0040. [PMID: 37669804 PMCID: PMC11169982 DOI: 10.3399/bjgpo.2023.0040] [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: 03/10/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND A mallet finger (MF) is diagnosed clinically and can be managed in primary care. The actual incidence of MF and how it is managed in primary care is unknown. AIM To determine the incidence of MF in primary care and to obtain estimates for the proportions of osseous and tendon MF. An additional aim was to gain insight into the management of patients diagnosed with MF in primary care. DESIGN & SETTING A cohort study using a healthcare registration database from general practice in the Netherlands. METHOD Patients aged ≥18 years with a new diagnosis of MF from 1 January 2015-31 December 2019 were selected using a search algorithm based on International Classification of Primary Care (ICPC) coding. RESULTS In total, 161 cases of MF were identified. The mean incidence was 0.58 per 1000 person-years. A radiograph was taken in 58% (n = 93) of cases; 23% (n = 37) of cases had an osseous MF. The most applied strategies were referral to secondary care (45%) or conservative treatment in GP practice (43%). Overall, 7% were referred to a paramedical professional. CONCLUSION On average, a Dutch GP assesses ≥1 patient with MF per year. Since only a minimal number of patients required surgical treatment and a limited number of GPs requested radiography, the recommendation in the guidelines to perform radiography in all patients with MF should potentially be reconsidered. The purpose of requesting radiographs should not be to distinguish between a tendinogenic or osseous MF, but to assess whether there is a possible indication for surgery.
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Evelien de Schepper
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrick Bindels
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Orthopedics & Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerald Kraan
- Department of Orthopedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Stumpfe MC, Suffa N, Merkel P, Ludolph I, Arkudas A, Horch RE. Quick and safe: why a k-wire-extension-block-fixation of a bony mallet finger is the favoured treatment. Arch Orthop Trauma Surg 2024; 144:1437-1442. [PMID: 38147078 PMCID: PMC10896929 DOI: 10.1007/s00402-023-05119-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 10/28/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Mallet fingers are the most common tendon injuries of the hand. Bony avulsion distal finger extensor tendon ruptures causing a mallet finger require special attention and management. In this monocentral study, we analyzed the clinical and individual outcomes succeeding minimal invasive k-wire extension block treatment of bony mallet fingers. MATERIALS AND METHODS In a retrospective study, we sent a self-designed template and a QUICK-DASH score questionnaire to all patients, who were treated because of a bony mallet finger between 2009 and 2022 and fulfilled the inclusion criteria. A total of 244 requests were sent out. 72 (29.5%) patients participated in the study. Forty-five men and twenty-seven women were included. RESULTS 98.7% (n = 75) of the cases were successfully treated. Patients were highly satisfied with the treatment (median 8.0; SD ± 2.9; range 1.0-10.0). Based on the QUICK-DASH score, all patients showed no difficulties in daily life. The extent of avulsion did not influence the outcome. CONCLUSION We conclude that the minimally invasive treatment of a bony mallet finger should be offered to every patient, because it is safe, fast, and reliable. Thus, we propose to perform extension-block pinning independently of the articular area.
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Affiliation(s)
- Maximilian C Stumpfe
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Nadine Suffa
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Pauline Merkel
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
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Shafiee E, Farzad M, Beikpour H. Orthotic Intervention with Custom-made Thermoplastic Material in Acute and Chronic Mallet Finger Injury: A Comparison of Outcomes. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:176-182. [PMID: 38577511 PMCID: PMC10989725 DOI: 10.22038/abjs.2023.60506.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 07/20/2023] [Indexed: 04/06/2024]
Abstract
Objectives To compare the effect of using custom-made orthosis on improving extension lag and reducing disability in acute and chronic mallet fingers. Methods We recruited 51 patients with acute or chronic Doyle type-1 mallet fingers, who were provided with a custom-made thermoplastic anti-mallet finger orthosis to wear full-time for 6 weeks and an additional 2 weeks at nighttime. The primary outcome, extension lag, was assessed at enrollment as well as six- and twelve-week follow-ups. Secondary outcomes included disability and satisfaction, which were evaluated using the Disability of the Arm, Shoulder, and Hand questionnaire at enrollment and 12 weeks, and a satisfaction scale at 12 weeks follow-up. Data analysis was conducted using univariate analysis of variance (ANOVA), one-way repeated measure mixed model analysis of covariance (ANCOVA), and independent sample t-test. Results A total of 43 participants, 25 acute and 18 chronic mallet fingers, completed the 12-week evaluation. The study found no significant difference between the two groups in terms of improvement in extension lag at either follow-up time point (P=0.21). Disability improved in both the acute and chronic groups at follow-up (P<0.05). Additionally, both groups expressed satisfaction with the treatment outcome, and no statistically significant difference was observed (t=0.173, P=0.51). We could not identify any clinically significant difference between the two groups in regard to extension lag, disability, or satisfaction at follow-up. Notably, 96% of the patients in the acute group and 88% of the patients in the chronic group demonstrated good to excellent outcomes. Conclusion Orthotic intervention with custom-made thermoplastic material in acute and chronic mallet fingers improved extension lag and disability, and both groups were satisfied with the treatment outcomes. The findings of our study indicated that patients with chronic mallet fingers benefited from orthotic interventions in the same way that patients with acute mallet fingers did.
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Affiliation(s)
- Erfan Shafiee
- University of Western Ontario, London, Ontario, Canada
| | - Maryam Farzad
- Assistant Professor, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- University of Western Ontario, London, Ontario, Canada
| | - Hadi Beikpour
- Reconstructive and Microsurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abubeih H, Abdelhameed MA, Morsy M, Khalifa AA, Mostafa KM, Said GZ. Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients. Rev Bras Ortop 2023; 58:e896-e904. [PMID: 38077774 PMCID: PMC10708977 DOI: 10.1055/s-0043-1771485] [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: 08/09/2022] [Accepted: 02/07/2023] [Indexed: 07/30/2024] Open
Abstract
Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type IIB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50° ° (range 20°-70°), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficial, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.
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Affiliation(s)
- Hossam Abubeih
- Cirurgião Ortopédico, Departamento de Ortopedia, Assiut University Hospital, Assiut, Egito
| | | | - Mohamed Morsy
- Cirurgião Ortopédico, Departamento de Ortopedia, Assiut University Hospital, Assiut, Egito
| | - Ahmed A. Khalifa
- Cirurgião Ortopédico, Departamento de Ortopedia, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egito
| | - Khaled Mohamed Mostafa
- Cirurgião Ortopédico, Departamento de Ortopedia, Assiut University Hospital, Assiut, Egito
| | - Galal Zaki Said
- Cirurgião Ortopédico, Departamento de Ortopedia, Assiut University Hospital, Assiut, Egito
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Slichter ME, Mathijssen NMC, Yau CCL, Koobs L, Kraan GA. Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures. J Hand Surg Am 2023:S0363-5023(23)00181-8. [PMID: 37191605 DOI: 10.1016/j.jhsa.2023.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 02/25/2023] [Accepted: 03/17/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. METHODS A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. RESULTS At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from -6° to -14°) and Michigan Hand Outcome Questionnaire score (median difference, -1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. CONCLUSIONS Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Malou Elisabeth Slichter
- Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA Zoetermeer, The Netherlands; Reinier de Graaf Hospital, Department of Orthopaedic Surgery, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands.
| | - Nina Maria Cornelia Mathijssen
- Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA Zoetermeer, The Netherlands; Reinier de Graaf Hospital, Department of Orthopaedic Surgery, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - Chris Chin Lien Yau
- Reinier de Graaf Hospital, Department of Orthopaedic Surgery, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - Linda Koobs
- Reinier de Graaf Hospital, Department of Radiology, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - Gerald Arnoldus Kraan
- Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA Zoetermeer, The Netherlands; Reinier de Graaf Hospital, Department of Orthopaedic Surgery, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
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Haddara MM, Kadar A, Ferreira LM, Suh N. Effect of a Flexor Digitorum Superficialis Hemitenodesis on Reducing Volar Plate Strains for Swan Neck Deformities. Hand (N Y) 2023; 18:421-429. [PMID: 34420424 PMCID: PMC10152534 DOI: 10.1177/15589447211040877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Flexor digitorum superficialis (FDS) hemitenodesis is a common procedure to treat swan neck deformity (SND). We hypothesize that this surgical technique is a biomechanically effective way to reduce strain in the volar plate at the proximal interphalangeal joint (PIPJ). METHODS Fifteen digits from 5 cadaveric specimens were tested using a novel in vitro active finger motion simulator under 4 finger conditions: intact, SND, FDS hemitenodesis, and FDS hemitenodesis with distal interphalangeal (DIP) joint fusion. Tensile loads in FDS and flexor digitorum profundus (FDP) and joint ranges of motion were measured by electromagnetic tracking. In addition, strain gauges were inserted under the volar plate to measure strain during PIPJ hyperextension. Results were analyzed using 1-way repeated-measures analysis of variance tests. RESULTS The SND condition increased volar plate strain by 176% ± 25% (P < .001) compared with the intact condition. The FDS hemitenodesis repair relieved more than 50% of the SND strain, restoring it to within no statistical difference from intact. The DIP fusion further reduced strain with no further statistical significance. At full flexion, FDS and FDP tendon loads diverged as a function of the test condition (P < .001). With the FDS hemitenodesis, the FDP load increased by 2.1 ± 1.5 N from the SND condition (P < .001), whereas the FDS load decreased by 1.3 ± 1.3 N (P = .012). CONCLUSION The FDS hemitenodesis repair restored strains to within 3.0 milli-strain of the intact condition with no significant difference. Application of DIP fusion did not further protect the PIPJ from increased hyperextension and further exacerbated the imbalance of flexor tendon loads.
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Affiliation(s)
| | | | - Louis M. Ferreira
- Western University, London, ON, Canada
- St. Joseph’s Health Care London, ON, Canada
| | - Nina Suh
- Western University, London, ON, Canada
- St. Joseph’s Health Care London, ON, Canada
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Sivakumar BS, Graham DJ, Ledgard JP, Lawson RD. Acute Mallet Finger Injuries-A Review. J Hand Surg Am 2023; 48:283-291. [PMID: 36509592 DOI: 10.1016/j.jhsa.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/28/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
Acute disruptions of the terminal extensor tendon are common and can result in significant dysfunction if not recognized and treated appropriately. This article provides a topical review of the contemporary literature concerning acute mallet finger injuries. It also proposes a modification to the Doyle classification to make it more encompassing and less prone to interobserver error.
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Affiliation(s)
- Brahman Shankar Sivakumar
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Australian Research Collaboration on Hands [ARCH], Mudgeeraba, Queensland, Australia; Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, the Faculty of Medicine and Health, the University of Sydney, Camperdown, Australia.
| | - David J Graham
- Australian Research Collaboration on Hands [ARCH], Mudgeeraba, Queensland, Australia; Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - James P Ledgard
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Richard D Lawson
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Peng C, Huang RW, Chen SH, Hsu CC, Lin CH, Lin YT, Lee CH. Comparative outcomes between surgical treatment and orthosis splint for mallet finger: a systematic review and meta-analysis. J Plast Surg Hand Surg 2023; 57:54-63. [PMID: 36625383 DOI: 10.1080/2000656x.2022.2164291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mallet finger is a commonly encountered condition in daily practice. However, there is currently no consensus on whether surgical intervention or conservative treatment with orthosis splint is superior. In this systematic review and meta-analysis, we compare the treatment outcomes between surgery and orthosis for bony and tendinous mallet finger. We searched PubMed, Embase, and the Cochrane Library according to the PRISMA guidelines from inception to January 15, 2021. The primary outcome was distal interphalangeal (DIP) joint extension lag angle, and secondary outcomes were DIP joint flexion and range of motion (ROM) angle. A total of 297 studies were initially identified, of which 13 (ten retrospective non-randomized controlled studies (non-RCTs) and three RCTs) were included in the final analysis. The results of this systematic review and meta-analysis showed that there was no high level of evidence supporting the superiority of surgery over orthosis in the treatment of mallet finger. Based on the available evidence, surgical intervention and conservative treatment with splint may offer similar clinical outcomes in both bony and tendinous mallet finger.
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Affiliation(s)
- Chi Peng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,International Master Science Program in Reconstructive Microsurgery, Chang Gung University, Taoyuan, Taiwan
| | - Che-Hsiung Lee
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Toci GR, Tecce ER, Katt BM, Aita D, Beredjiklian PK, Fletcher D. Splinting versus Percutaneous Pinning for the Treatment of Soft Tissue Mallet Finger: A Retrospective Cohort Analysis. J Hand Surg Asian Pac Vol 2022; 27:952-956. [PMID: 36476089 DOI: 10.1142/s2424835522500886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The purpose of this study was to compare percutaneous pinning versus splinting of soft tissue mallet finger injury to determine if there are differences in residual extensor lag and complication rates. Methods: Patients ≥18 years of age undergoing mallet finger injury treatment from 2011 to 2020 were retrospectively reviewed. Exclusion criteria included bony or open mallet finger injury and incomplete documentation of residual extensor lag at final follow-up. Complications, including infection, hardware fixation failure and wound complications, were collected from follow-up clinic notes. Those treated with percutaneous pinning were compared to those treated non-surgically with splinting. Results: Of the 150 soft tissue mallet finger injuries that met the inclusion criteria, 126 were treated with splinting, and 24 were treated with percutaneous pinning. There were no differences in residual extensor lag between groups (Splinting: 5.4°, Pinning: 5.8°, p = 0.874). However, the pinning group had a higher overall complication rate than the splinting group (20.8% vs. 1.6%, p = 0.001). Conclusions: Surgery may be an effective treatment method for soft tissue mallet finger, but due to the higher rate of complication and the increased expense of a surgical procedure, splinting should be the preferred treatment method for most of these injuries. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Gregory R Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric R Tecce
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian M Katt
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Daren Aita
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Pedro K Beredjiklian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Fletcher
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Tranier M, Bacle G, Laulan J, Morante De Los Reyes A, Dechir Y, Roulet S. Management of chronic mallet finger: Indications and long-term results of Fowler central slip tenotomy and distal interphalangeal joint arthrodesis. Orthop Traumatol Surg Res 2022; 109:103487. [PMID: 36435374 DOI: 10.1016/j.otsr.2022.103487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/21/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Many surgical techniques have been described to correct the sequelae of chronic mallet fingers (MF), but no clear therapeutic strategy has been defined. We have reported the choice of their management according to the severity of the deformities. Two procedures were compared: Fowler's central slip tenotomy (CST) and arthrodesis of the distal interphalangeal joint (DIP). HYPOTHESIS The use of our decision tree, based on the severity of deformity (flexion deformity at the DIP and recurvatum at the proximal interphalangeal joint), allows good long-term clinical results to be obtained. MATERIAL AND METHODS Thirty-three patients (34 fingers) were operated on for sequelae of chronic MF either by CST or by DIP arthrodesis. Patients with ≤35° DIP flexion deformity and <25° proximal interphalangeal (PIP) recurvatum, without DIP joint involvement (osteoarthritis, subluxation, stiffness), were treated with CST. For the others, arthrodesis of the DIP joint was performed. RESULTS Thirteen patients (13 fingers) were evaluated in the CST group with a mean follow-up of 13 years. There were no postoperative complications and no failures. The mean DIP residual extension lag was 4.23° with complete correction of the PIP recurvatum. All patients would redo the intervention in hindsight. The improvement in Quick-DASH was statistically significant (p=0.01). Twenty patients (21 fingers) were included in the DIP arthrodesis group with a mean follow-up of 10 years. Two failures (9.5%) occurred due to failed correction of the PIP recurvatum. No worsening of the deformities was reported, and they were corrected in 90% of cases. The absence of correction of the PIP recurvatum was more frequent in MF bone (p=0.01). All except 1 (95%) patient, who reported a lack of mobility of the DIP joint, would repeat the procedure. Quick-DASH was improved for all patients. DISCUSSION CST is effective in correcting deformities in chronic MFs for ≤35° DIP flexion deformity and <25° PIP recurvatum without DIP joint involvement. In other cases, it is preferable to perform a DIP arthrodesis by combining, if necessary, a complementary procedure to correct the PIP recurvatum. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Manon Tranier
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, avenue de la République, 37000 Tours, France.
| | - Guillaume Bacle
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, avenue de la République, 37000 Tours, France
| | - Jacky Laulan
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, avenue de la République, 37000 Tours, France
| | - Alexandre Morante De Los Reyes
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, avenue de la République, 37000 Tours, France
| | - Yanis Dechir
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, avenue de la République, 37000 Tours, France
| | - Steven Roulet
- ELSAN, clinique Belledonne, 83, avenue Gabriel-Péri, 38400 St-Martin-d'Hères, France
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Cavanaugh PK, Watkins C, Jones C, Maltenfort MG, Beredjiklian PK, Rivlin M. Effectiveness of Quickcast Versus Custom-Fabricated Thermoplastic Orthosis Immobilization for the Treatment of Mallet Fingers: A Randomized Clinical Trial. Hand (N Y) 2022; 17:1090-1097. [PMID: 33511868 PMCID: PMC9608300 DOI: 10.1177/1558944720988136] [Citation(s) in RCA: 2] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mallet finger is a common injury involving a detachment of the terminal extensor tendon from the distal phalanx. This injury is usually treated with immobilization in a cast or splint. The purpose of this study is to compare outcomes of mallet fingers treated with either a cast (Quickcast) or a traditional thermoplastic custom-fabricated orthosis. METHODS Our study was a prospective, assessor-blinded, single-center randomized clinical trial of 58 consecutive patients with the diagnosis of bony or soft tissue mallet finger treated with immobilization. Patients were randomized to either an orfilight thermoplastic custom-fabricated orthosis or a Quickcast orthosis. Patients were evaluated at 3, 6, and 10 weeks for bony and 4, 8, and 12 weeks for soft tissue mallets. Skin complications, pain with orthosis, compliance, need for surgical intervention, and extensor lag were compared between the 2 groups. RESULTS Both bony and soft tissue mallet finger patients experienced significantly less skin complications (33% vs 64%) and pain (11.2 vs 21.6) when using Quickcast versus an orfilight thermoplastic custom-fabricated orthosis. The soft tissue mallet group revealed a greater difference in pain, favoring Quickcast (6.2 vs 22). No significant difference in final extensor droop or need for secondary surgery was found between the 2 groups. CONCLUSIONS Quickcast immobilization for the treatment of mallet finger demonstrated fewer skin complications and less pain compared with orfilight custom-fabricated splints.
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Affiliation(s)
| | | | | | | | | | - Michael Rivlin
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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14
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Giddins G. Mallet Finger: Two Different Injuries. Hand Clin 2022; 38:281-288. [PMID: 35985751 DOI: 10.1016/j.hcl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8 weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 310 (range 3°-590) in the patients treated in my unit. In contrast, bony mallet injuries occur at a younger age (mean 40 years) and are always due to high energy injuries. The injuries are always painful. The commonly injured fingers are the ring and little fingers. There are multiple injuries in 3% (range 2%-5%) and in 4% to 8% of cases, there are concomitant (nondigital) injuries according to data in my unit. Radiologically there is an appreciably smaller extensor lag; mean 130 (range 0°-400). In particular, bony mallet injuries are extension compression, not avulsion, fractures which should not logically be treated with an extension splint which will reproduce the direction of injury.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, Bath, Bath, United Kingdom; Royal United Hospital, Bath, United Kingdom; University of Bath, Bath, United Kingdom.
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15
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Brush M, Dick NR, Rohman EM, Bohn DC. Comparison of Orthosis Management Failure Rates for Mallet Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:220-225. [PMID: 35880156 PMCID: PMC9308152 DOI: 10.1016/j.jhsg.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/05/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose A closed mallet injury is a common finger injury involving terminal extensor tendon avulsion from its insertion on the distal phalanx. Nonsurgical treatment with continuous extension orthosis fabrication is the preferred treatment. Our purpose was to report the failure rates of orthotic management by digit and investigate other factors that contribute to failure. Methods This was a retrospective chart review of all patients with an isolated mallet finger injury managed at our institution from 2011 to 2019. Patient demographics, details of management, and treatment outcomes were collected. Failure rates were compared for all digits, specifically comparing the little finger versus all other digits. A categorical variable analysis was performed to identify risk factors for failure of orthosis management. Results Out of 1,331 identified patients, 328 met the inclusion criteria. There was no statistically significant difference of failure rate between digits. There was a trend toward the little finger failing at a higher rate (n = 131, 40%) than the other digits individually (P = .08) and combined (n = 95, 29%; P = .06). An older age at injury was associated with failure. The median patient age with failure was 54 years, versus the median patient age with nonfailure of 48 years (P < .01). The failure rate was higher in tendinous versus bony mallet injuries (n = 131, 40% vs n = 66, 20%, respectively; P < .01). The orthotic type was associated with the failure rate, and failure was highest in patients treated with Stack orthoses (n = 183, 56%; P = .01). Conclusions There was no significant difference in the orthotic management failure rate by digit for a mallet injury. Statistically significant risk factors for failure are increasing age, a tendinous injury, and the orthotic type. Further evaluation with a larger cohort is warranted to increase the statistical power of the findings. Type of study/level of evidence Therapeutic III.
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Affiliation(s)
- Michael Brush
- University of Minnesota Medical School, Minneapolis, MN
| | | | - Eric M. Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Deborah C. Bohn
- TRIA Orthopaedic Center, Bloomington, MN
- Corresponding Author: Deborah C. Bohn, MD, TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431.
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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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Khera B, Chang C, Bhat W. An overview of mallet finger injuries. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021246. [PMID: 34738569 PMCID: PMC8689306 DOI: 10.23750/abm.v92i5.11731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022]
Abstract
Mallet finger describes a fingertip deformity where the distal interphalangeal joint (DIPJ) of the affected digit is held in flexion, unable to extend the distal phalanx actively. The deformity is typically a consequence of traumatic disruption to the terminal extensor tendon at its insertion at the proximal portion of the distal phalanx or slightly proximally at the level of the DIPJ. Patients typically present with a history describing the event of injury with a typical mallet deformity. Common mechanisms include sport activities causing a direct blow to the finger, low energy trauma while performing simple tasks such as pulling up socks or crush injuries from getting the finger trapped in a door. The DIPJ can be passively extended, but this extension of the joint cannot be maintained once the passive extension is stopped. The Doyle classification can be used to categorise and dictate treatment. The extensor lag associated with the deformity does not improve spontaneously without treatment. Inappropriate management can lead to chronic functional loss and stiffness of the finger. The majority of closed mallet splints are Doyle type I, which can be managed non-surgically with external splints, worn full-time to keep the fingertip straight until the tendon injury or fracture heals. Surgical techniques is considered for other types of mallet injuries. Techniques used include closed reduction and Kirschner wire fixation, open reduction and internal fixation, reconstruction of the terminal extensor tendon and correction of swan neck deformity.
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Affiliation(s)
| | - Chad Chang
- University Hospital of North Durham, Durham, U.K..
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18
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Vonderlind HC, Eisenschenk A, Strüwer J, Millrose M. [Arthrodesis of the distal interphalangeal Joint - a literature Review]. HANDCHIR MIKROCHIR P 2021; 54:5-20. [PMID: 34544198 DOI: 10.1055/a-1560-2677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This review addresses the arthrodesis of the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb with focus on indications, approaches, preparation of the articular surfaces, the angle of arthrodesis, advances and disadvantages of each technique, and postoperative care.
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Affiliation(s)
| | - Andreas Eisenschenk
- Unfallkrankenhaus Berlin Abteilung für Hand-, Replantations- und Mikrochirurgie
| | - Johannes Strüwer
- Klinikum Oldenburg AoR Universitätsklinik für Orthopädie und Unfallchirurgie
| | - Michael Millrose
- Klinikum Garmisch-Partenkirchen, Abteilung für Unfallchirurgie, Sportorthopädie & Kindertraumatologie
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19
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Extension pin block technique versus extension orthosis for acute bony mallet finger; a retrospective comparison. Orthop Traumatol Surg Res 2021; 107:102764. [PMID: 33333280 DOI: 10.1016/j.otsr.2020.102764] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/17/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aimed to compare the clinical, radiological, aesthetic and economic outcomes of extension pin block technique and extension orthosis in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation (Wehbe and Schneider classification type IB and IC). MATERIALS AND METHODS Thirty-nine patients (11 women and 28 men; mean age: 40.9±11.5 years) who had mallet fractures were retrospectively reviewed. Twenty-one patients were treated with the extension pin block technique, and the remaining 18 were treated with the extension orthosis. Fracture classification, measurement of articular surface involvement, presence of subluxation, and the fragment displacement were performed according to the Wehbe and Schneider classification. Crawford's criteria, extension lag, distal interphalangeal joint (DIPJ) range of motion, dorsal bump, and visual analog scale were evaluated. Fracture union, articular incongruity, and all other complications were followed and analyzed. The Michigan Hand Questionnaire (MHQ) was used to evaluate the aesthetic perception of the patient's finger. Direct and indirect costs were calculated for each treatment method. RESULTS At the final follow-up (mean: 18.4±6.2 months), there was no significant difference with respect to clinical outcomes between groups (p=0.335) and pain (p=0.131). Fracture union was achieved in all cases. Both extension lag (p=0.150) and DIPJ flexion (p=0.261) were not different between groups. Dorsal bump was more frequent in the conservative treatment group (p=0.048). Aesthetic scores were similar between groups (p=0.477), but female patients rated significantly lower aesthetic scores than males (p=0.003) regardless of the treatment method. The direct medical (p=0.001), indirect (p=0.009) and cumulative costs (p=0.001) were significantly higher in surgical treatment group. One pin tract infection, one nail dystrophy, and one joint space narrowing were seen in the surgical treatment group versus none in the conservative treatment group (p=0.698). CONCLUSIONS Conservative treatment does not result in inferior clinical, radiographic and aesthetic outcomes compared to surgical fixation in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation. Extension orthosis which is non-invasive, and cheap, maybe the treatment of choice in closed mallet fractures. LEVEL OF EVIDENCE IV; Retrospective cohort.
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20
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Ozturk T, Erpala F, Zengin EC, Eren MB, Balta O. Comparison of interfragmentary pinning versus the extension block technique for acute Doyle type 4c mallet finger. HAND SURGERY & REHABILITATION 2021; 41:131-136. [PMID: 33848651 DOI: 10.1016/j.hansur.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/21/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to compare the closed reduction interfragmentary pinning method (IPM) with the extension block technique (EBT) for bony mallet finger. Patients who underwent mallet finger operations were screened retrospectively for the following inclusion criteria: Doyle type 4c, age between 18 and 75 years, less than 4 weeks to surgery, and more than 1 year of follow-up time. Group I underwent a closed reduction IPM, and group II underwent the EBT. Lateral radiographs taken during the preoperative and final examination were used to evaluate the size and amount of displacement from the distal interphalangeal (DIP) joint and the dorsal fragment as well as the articular surface. Operation times were compiled from patient records. During the final examination, pain and DIP joint range of motion (ROM) were assessed and complications were recorded. The Crawford criteria were used for functional results. Fifteen patients in group I (8 men, 7 women) and 17 patients in group II (10 men, 7 women) were evaluated. Age, gender, time to surgery and follow-up time showed no statistically significant differences between the two groups. The differences in fragment size, preoperative and postoperative joint displacement, amount of dorsal displacement and DIP joint ROM were not statistically significant between the two groups. However, the operation time was significantly shorter time in group I than in group II (p=0.000). The average time to fracture union was significantly longer in group I (7.3 weeks) than in group II (6 weeks) (p=0.013). The EBT has faster time to union and is a safer method with lesser risk of arthritis and fragmentation. The IPM can be an alternative with shorter operation time, less pin bed infection and nail bed damage, especially in Doyle type 4c cases with large fragments.
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Affiliation(s)
- T Ozturk
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Tokat, Mah. Muhittin Fisunoğlu Cad. Ali Şevki Erek Yerleşkesi, Merkez/Tokat, Turkey
| | - F Erpala
- Department of Orthopaedics and Traumatology, Cesme Alpercizgenakat State Hospital Izmir, Fahrettinpasa Mah, Boyalık Mevki Ilıca Yolu, SOK. NO 2/A, 35930 Çeşme/İzmir, Turkey.
| | - E C Zengin
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Tokat, Mah. Muhittin Fisunoğlu Cad. Ali Şevki Erek Yerleşkesi, Merkez/Tokat, Turkey
| | - M B Eren
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Tokat, Mah. Muhittin Fisunoğlu Cad. Ali Şevki Erek Yerleşkesi, Merkez/Tokat, Turkey
| | - O Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Tokat, Mah. Muhittin Fisunoğlu Cad. Ali Şevki Erek Yerleşkesi, Merkez/Tokat, Turkey
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21
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Suzuki T, Iwamoto T, Matsumura N, Kimura H, Nakamura M, Matsumoto M, Sato K. Causes of Procedural Failures of Closed Reductions using an Extension-Block Pin for Bony Mallet Finger. J Hand Microsurg 2021; 13:69-74. [PMID: 33867764 PMCID: PMC8041496 DOI: 10.1055/s-0040-1701318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This retrospective study evaluated procedural failures of closed reductions using an extension-block Kirschner wire (K-wire) for bony mallet finger. A total of 132 patients who underwent a closed reduction for bony mallet finger in a procedure using an extension-block K-wire were radiographically assessed. Radiographs were used to evaluate (1) postoperative displacement of the reduction before or after K-wire removal and (2) inaccurate reduction of the fragment immediately after surgery. The causes of procedural failure and bone union were evaluated using radiographs and medical records of the intraoperative findings. Out of 132 patients, 17 with procedural failure were enrolled. Displacement of the reduction before and after K-wire removal occurred in seven and six cases, respectively. Inaccurate reduction immediately after surgery occurred in four cases. The most common cause of procedural failure was inaccurate insertion of the K-wire to fix the distal interphalangeal joint (eight cases) followed by inaccurate insertion of the extension-block pin (five cases). All patients had bone union regardless of the displacement of the reduction or inaccurate reduction of the fragment. Caution should be exercised during the reduction and fixation when an extension-block K-wire is used in a closed reduction procedure.
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Affiliation(s)
- Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
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22
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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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Bastien J, Rouzaud S. When should splint treatment start for a tendinous mallet finger? A retrospective review of 319 fingers. HAND SURGERY & REHABILITATION 2021; 40:491-494. [PMID: 33775888 DOI: 10.1016/j.hansur.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- J Bastien
- Department of Hand Surgery, Institut Aquitain de la Main, 56 Allée des Tulipes, 33600 Pessac, France
| | - S Rouzaud
- Department of Hand Surgery, Institut Aquitain de la Main, 56 Allée des Tulipes, 33600 Pessac, France.
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24
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Huang Y, Wu K, Shi H, Shen Y, Zhang Z, Rui Y. Kirscner wire fixation versus suture anchor technique for mallet finger: A meta-analysis. Medicine (Baltimore) 2021; 100:e24996. [PMID: 33725972 PMCID: PMC7982224 DOI: 10.1097/md.0000000000024996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Though the previous studies had described various surgical techniques for the treatment of mallet finger injuries, consensus on which technique was the most effective and appropriate surgical methods had not yet reached. This review aimed to systematically compare the effectiveness and safety of the treatment for mallet finger injuries via Kirschner wire fixation versus suture anchor technique to recommend an optimum option. METHODS All literatures published until December 31, 2019 compared Kirschner wire fixation versus suture anchor technique to treat mallet finger were acquired through a comprehensive search in multiple databases. A meta-analysis was performed by the Cochrane Collaboration's RevMan 5.3 software. RESULTS A total of 8 trials with 362 cases consisted of 4 randomized controlled trials and 4 prospective studies. The results suggested that the groups treated with kirschner wire fixation experienced more significant advantage in less complications than suture anchor groups (P < .05). On the other hand, no significant differences were found in terms of the total active range motion of the distal interphalangeal joint, the average distal interphalangeal joint extensor lag, Visual Analogue Scale scores, recurrence, as well as functional assessment at the final follow-up (P > .05, respectively) between the two surgical procedures. CONCLUSIONS No obvious superiority were shown for the effectiveness between the two surgical interventions based on the above results. But in view of the less economic spending and complications, Kirschner wire fixation should be a better alternative relative to the suture anchor technique for inevitable surgical treatment of mallet finger lesions. However, a prudent attitude is still necessary to choose the two operative managements before a large sample and high-quality randomized controlled trials had been performed.
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Outcomes of conservative treatment for bony mallet fingers. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1493-1499. [PMID: 33646388 DOI: 10.1007/s00590-021-02914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The treatment strategy for bony mallet fingers remains controversial. The outcomes of conservative treatment were investigated in this study. In addition, the time to bone union, and gap between the bone fragment and distal phalanx are discussed. METHODS The subjects were 26 patients (27 fingers) with bony mallet fingers (20 males and 6 females, mean age: 46.0 years old, the mean limitation of extension of the distal interphalangeal (DIP) joint: - 20.2°). In conservative treatment, splinting was applied for 6 weeks, followed by 2-week taping. The time to bone union, range of motion of the DIP joint, and the Crawford classification on the final follow-up were investigated. In addition, the bone fragment occupation rate was evaluated on plain radiography on the first examination. Furthermore, the gap on the first examination and after splinting. The relationship between the gap and bone union period was also investigated. RESULTS The mean time from injury to bone union was 170.2 days, the mean range of motion of the DIP joint was - 8.5° in extension and 60.9° in flexion, and the Crawford classification was Excellent for 22 fingers, Good for 2, Fair for 2, and Poor for 1. On the first examination, the mean bone fragment occupation rate was 44.0%. The mean gap on the first examination was 1.1 mm and this was significantly narrowed to 0.8 mm after splinting (p < 0.01). No significant correlation was noted between the time to bone union and gap on the first examination (p = 0.16), however, a significant positive correlation was noted between them after splinting (p < 0.01). CONCLUSIONS This study suggested that a favorable clinical outcome can be achieved by conservative treatment. Moreover, the bone union period decreased as the gap after splinting decreased, being significantly correlated.
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Afshar A, Tabrizi A, Taleb H. A Bony Mallet Thumb with Interposition of the Nail Plate. Surg J (N Y) 2021; 7:e18-e21. [PMID: 33542952 PMCID: PMC7850894 DOI: 10.1055/s-0040-1722181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 09/09/2020] [Indexed: 10/31/2022] Open
Abstract
Thumb extensor injuries and bony avulsion in the distal phalanx of the thumb are rare compared with other fingers. The most reported complications are infection, nail deformity, joint incongruity, implant failure, recurrent flexion deformity, and residual pain. This report presents a case of 30-year-old man suffering from an injury in the left thumb distal phalanx with a displaced comminuted intra-articular fracture of the distal phalanx of the left thumb. The nail plate was interposed between the dorsal and palmar fragments. The interposition of the nail plate in the bony mallet thumb has not been described before. Surgical treatment and fixation with a 2-mm miniscrew resulted in successful treatment. Clinical suspicion of this complication is of great importance and can affect treatment outcomes.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini University Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini University Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Hassan Taleb
- Department of Orthopedics, Imam Khomeini University Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Abstract
Acute tendon and bony injuries of the distal phalanx are challenging injuries because they may result in chronic pain, hypersensitivity, stiffness, and deformity if they are not adequately treated. Flexor tendon avulsions require early surgical repair. Conversely, most extensor tendon injuries and fractures heal well with nonoperative treatment. However, surgery is indicated in selected patients, and meticulous technique is required to achieve good postoperative outcomes. In this article, we outline the pertinent clinical anatomy of the distal phalanx, review the current literature regarding treatment options, and highlight key management points to ensure good clinical outcomes while minimizing complications.
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Affiliation(s)
- Janice C Y Liao
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore; Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Soumen Das De
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
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Rocchi L, Fulchignoni C, De Vitis R, Molayem I, Caviglia D. Extension Block Pinning Vs Single Kirshner Wiring To Treat Bony Mallet Finger. A Retrospective Study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021535. [PMID: 35604272 PMCID: PMC9437690 DOI: 10.23750/abm.v92is3.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND AIM Bony Mallet Finger or Mallet Fracture is a common injury of the hand, which follows a forced flexion of the extended distal interphalangeal joint, that leads to a bony avulsion of the distal phalanx. Depending on fracture extension and dislocation, those lesions can either be treated conservatively or surgically. Several surgical options have been described in the literature. The aim of this study is to compare retrospectively two percutaneous pinning techniques: the extension block technique according to Ishiguro vs an original single Kirshner wiring (Umbrella technique). METHODS Between January 1998 and December 2019, among all patients treated surgically for a Mallet Fracture with either the Ishiguro' and the Umbrella technique, 98 have been included in this study. All patients have been assessed one year after surgery using the Crawford method. RESULTS With both techniques better results have been achieved in younger patients and for those treated early. The umbrella technique seems to have better results in patients with fracture classified as 2b or 2c (Wehbe and Schneider classification), whereas the Ishiguro technique seems more appropriate for patients with a 1b fracture. Complication rate and typology vary depending on the used technique. CONCLUSIONS The Ishiguro' and the Umbrella technique both lead to good results for the treatment of surgical Mallet Fractures. The choice of the best type of pinning should mainly depend on fracture extension and time elapsed from trauma.
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Affiliation(s)
- Lorenzo Rocchi
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
| | - Camillo Fulchignoni
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
| | - Rocco De Vitis
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
| | - Iakov Molayem
- Hand Surgery, Microsurgery and Upper Limb Unit — “Israelitico” Hospital of Rome, Italy
| | - Daniele Caviglia
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
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Chen D, Liu J, Zhang Z. 'Panel-pin' technique for mallet fractures. J Hand Surg Eur Vol 2020; 45:995-997. [PMID: 32538289 DOI: 10.1177/1753193420930606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Dongliang Chen
- Department of Hand Surgery, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Jiangjun Liu
- Department of Hand Surgery, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Zengfang Zhang
- Department of Hand Surgery, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Gumussuyu G, Asoglu MM, Unal M, Turan A, Kose O. Reliability of subluxation and articular involvement measurements during the assessment of bony mallet finger. HAND SURGERY & REHABILITATION 2020; 40:87-92. [PMID: 32961286 DOI: 10.1016/j.hansur.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate the reliability of distal interphalangeal joint (DIPJ) subluxation and articular surface involvement measurements during the assessment of bony mallet finger. Two observers measured articular involvement, subluxation ratio and rated joint congruency on 30 lateral radiographs of patients with bony mallet finger on two separate occasions. All measurements and ratings were done on magnified digital radiographs on a workstation. The intraclass correlation coefficient (ICC) and kappa statistics were used to establish relative agreement between observers. The intra-observer reliability for articular involvement and subluxation ratio were good for Observer A (ICCs 0.888 and 0.775) and excellent for Observer B (ICCs 0.958 and 0.910) on both occasions. However, the subluxation rating was moderate for both observers (kappa 0.772 and 0.780, respectively). Inter-observer reliability for articular involvement (ICC 0.884) and the subluxation ratio (ICC 0.818) was good on the first measurement. Although the subluxation rating was perfect for the first measurement (kappa 0.927), it was moderate for the second (kappa, 0.619). The reliability of articular involvement (%) and subluxation ratio (%) measurement was good and excellent. However, the decision on whether the DIPJ is congruent or incongruent was only moderately reproducible. These findings show us that surgeons should be cautious when assessing subluxation, which is the most important criterion for choosing the appropriate treatment.
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Affiliation(s)
- G Gumussuyu
- Altinbas University, Medical Faculty, Department of Orthopedics and Traumatology, Mahmutbey, Dilmenler cd. No:26, 34217 Istanbul, Turkey.
| | - M M Asoglu
- Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Soguksu mah. Kazım Karabekir cd., 07100 Antalya, Turkey.
| | - M Unal
- Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Soguksu mah. Kazım Karabekir cd., 07100 Antalya, Turkey.
| | - A Turan
- Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Soguksu mah. Kazım Karabekir cd., 07100 Antalya, Turkey.
| | - O Kose
- Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Soguksu mah. Kazım Karabekir cd., 07100 Antalya, Turkey.
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Duarte A. Optimising the conservative management of closed tendinous mallet finger injury. Emerg Nurse 2020; 28:35-40. [PMID: 32573149 DOI: 10.7748/en.2020.e1974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 12/23/2022]
Abstract
Mallet finger injuries are a common presentation in the emergency department. These injuries result from a forced flexion at the distal interphalangeal joint (DIPJ) that causes extensor tendon disruption, and possibly bone avulsion, at the base of the distal phalanx. This article describes the anatomy, mechanisms, classification and assessment of mallet finger injury. It reviews different types of splints used in the conservative management of closed tendinous mallet finger injury and discusses the latest evidence regarding immobilisation methods and treatment duration. Maintaining the DIPJ in extension during treatment is essential, so the article stresses the importance of patient adherence to treatment.
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Abstract
In treating hand fractures, we have to make a proper decision about conservative treatment versus surgical intervention and decide on individual surgical methods. This article reviews recent publications, technical advances, and outcome measures in treating metacarpal fractures, phalangeal fractures, complex fractures of the proximal interphalangeal joints, bony mallet fingers, and fractures of the thumb. My personal preferences and considerations are presented. At the end, the current challenges that hand surgeons are facing in treating frequent phalangeal and metacarpal fractures are discussed.
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Barrios SAD, Serrano AFDJS, Herrera JAG, Berumen MFR, Atanasio JMP. OUTCOME OF NON-SURGICAL TREATMENT OF MALLET FINGER. ACTA ORTOPEDICA BRASILEIRA 2020; 28:172-176. [PMID: 32788858 PMCID: PMC7405845 DOI: 10.1590/1413-785220202804230335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To establish the association between initial and residual angulation of the distal interphalangeal joint (DIJ) in mallet finger treated conservatively. METHODS An observational, prospective, descriptive and analytical research developed with uncomplicated closed mallet finger patients between January and December 2017. A total of two measurements of the DIJ were done, at the initial trauma and 6 weeks after conservative treatment. All measurements were ranked according to the Crawford Classification and Relative Risk was measured. RESULTS In total, 43 patients were studied, in which 53.48% of outcomes obtained were excellent. The sample was divided in two groups; one with less than 30º of DIJ initial angulation, which had 28% of residual angulation. The second group with more than 30º presented 72.22% of residual angulation. The Relative Risk to present a residual angulation in patients that had 30º of DIJ initial angulation was 2.99 (CI 95%) with p = 0.0059. CONCLUSION It is suggested that patients with an initial DIJ angulation more than 30º are more likely to present residual angulation with conservative treatment. Level of Evidence IV, Case series.
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de Vena Franks PL, Lightfoot NJ. Mallet finger in an anaesthetist following tracheal intubation. Anaesth Rep 2020; 8:127-130. [PMID: 33210089 DOI: 10.1002/anr3.12073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 11/05/2022] Open
Abstract
We describe an unusual work-related mallet finger injury sustained by an anaesthetist at the time of induction of anaesthesia. Although injuries in healthcare workers are common, they are rarely described in the literature, and this is the first time that such an injury has been described in this setting. The injury was managed non-surgically and after a significant time away from clinical duties, the anaesthetist made a good recovery and returned to clinical work. Potential contributing factors and preventative strategies are discussed in order to help anaesthetists avoid similar injuries occurring in future.
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Affiliation(s)
| | - N J Lightfoot
- Counties Manukau Health Middlemore Hospital Auckland New Zealand
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35
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Percutaneous Tenodermodesis for Mallet Fingers: An Office-based Procedure. Tech Hand Up Extrem Surg 2020; 25:56-58. [PMID: 32520774 DOI: 10.1097/bth.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mallet fingers are injuries to the extensor tendon at the distal interphalangeal (DIP) joint and can present as a bony avulsion or as a soft tissue injury. Nonbony mallet fingers are frequently splinted in extension between 6 and 8 weeks. If splinted correctly, most results are good with a mean DIP joint extension lag between 5 and 10 degrees. However, decreased swelling, hygienic considerations and patient compliance can lead to splint removal and a less favorable outcome. We present a percutaneous tenodermodesis using only a digital block and a 4.0 nylon suture. This office-based procedure provides joint reduction and prevents joint movement during the immobilization period. The suture can be removed after 8 weeks, allowing active mobilization of the DIP joint. We present the results of 8 patients with a mean follow-up of 3 months and mean initial extension lag of 32 degrees, resulting in a mean final extension lag of 2 degrees and excellent outcomes using the Crawford criteria.
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Nagura S, Suzuki T, Iwamoto T, Matsumura N, Nakamura M, Matsumoto M, Sato K. A Comparison of Splint Versus Pinning the Distal Interphalangeal Joint for Acute Closed Tendinous Mallet Injuries. J Hand Surg Asian Pac Vol 2020; 25:172-176. [PMID: 32312200 DOI: 10.1142/s2424835520500198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The vast majority of acute closed tendinous mallet injuries are treated with a splint. Very few studies have directly compared splinting versus pinning the distal interphalangeal joint for this injury. The aim of this cohort study is to determine the outcomes of both methods. Methods: A total of 59 patients with acute tendinous mallet injury were retrospectively enrolled (29 patients in conservative treatment and 30 patients in surgical treatment). Conservative treatment was performed using custom-made thermoplastic splint and surgical treatment was conducted with oblique K-wire fixation of the distal interphalangeal (DIP) joint. The DIP joint was immobilized for eight weeks in both treatments. Active ranges of motion of the affected finger and Miller's classification were evaluated postoperatively. Results: The mean extension lag of the DIP joint in the surgical treatment group was significantly better than it was with conservative treatment (2.1° vs 13.8°). Three patients who were noncompliant with the splint showed poor results, while no patients in the surgical treatment group had a poor result. Conclusions: Surgical treatment with K-wire fixation leads to satisfactory results for acute tendinous mallet injury.
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Affiliation(s)
- Shigeki Nagura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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McGhee S, Gonzalez J, Nadeau C, Ortega J. Mallet finger injuries: the signs, symptoms, diagnosis and management. Emerg Nurse 2020; 28:e1996. [PMID: 32153150 DOI: 10.7748/en.2020.e1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 11/09/2022]
Abstract
Patients commonly present to UK emergency departments with injuries to the tips of their fingers. Mallet finger is one of the most common injuries, resulting from an injury to the extensor tendon over the dorsal surface of the distal phalanges of the hand. Timely recognition, diagnosis and management are required to prevent complications. This article provides an overview of the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries.
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Affiliation(s)
- Stephen McGhee
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, United States
| | - Juan Gonzalez
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, United States
| | - Catherine Nadeau
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, United States
| | - Johis Ortega
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, United States
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Batıbay SG, Akgül T, Bayram S, Ayık Ö, Durmaz H. Conservative management equally effective to new suture anchor technique for acute mallet finger deformity: A prospective randomized clinical trial. J Hand Ther 2019; 31:429-436. [PMID: 28966061 DOI: 10.1016/j.jht.2017.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective randomized controlled trial. PURPOSE OF THE STUDY This study was designed to compare our new suture anchor technique with conservative management in acute Wehbe-Schneider type I A-B and II A-B mallet fingers. METHODS Twenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe-Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow-up time was 12 months. RESULTS The mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow-up was 54.5° (40-65) in the surgery group and 58.3° (45-70) in the conservative group. DIP joint degeneration was observed with X-rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. CONCLUSIONS The therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. LEVEL OF EVIDENCE Ib.
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Affiliation(s)
- Sefa Giray Batıbay
- Department of Orthopedics and Trauma, Umraniye Education and Research Hospital, İstanbul, Turkey
| | - Turgut Akgül
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Serkan Bayram
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey.
| | - Ömer Ayık
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Hayati Durmaz
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
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40
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Chen Q, Suo Y, Pan D, Xie Q. Elastic fixation of mallet finger fractures using two K-wires: A case report of a new fixation technique. Medicine (Baltimore) 2019; 98:e15481. [PMID: 31096445 PMCID: PMC6531267 DOI: 10.1097/md.0000000000015481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Mallet finger fracture is a common sports-related injury that may lead to the tearing of extensor tendon and protrusion of a bony fragment located at the base of the distal phalanx. We affirmed that the elastic fixation of with two K-wires technique is a good method to deal with Mallet Finger fractures that fractures could gain effective fixation than the conventional treatment method and avoid surgical incision complication PATIENT CONCERNS:: We reported a 33-year-old female patient came to our hospital complaining of mild pain, swelling and her right little finger was deformed because of sport's injury. DIAGNOSIS Acute mallet finger fracture type IV B according to Doyle classification of mallet injuries. INTERVENTIONS We performed an emergency operation for the elastic fixation of the mallet finger fractures with two K-wires. OUTCOMES After the surgery, the patient showed functional recovery. No evidence of recurrence was noted 6 months after the operation, and the patient showed no symptoms of sports-related injuries. LESSONS We discuss the clinical diagnosis, treatment, and follow-up of the patient and suggest that elastic fixation with two K-wires is a good method to treat mallet finger fractures.
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Treatment of tendinous mallet fingers using a Stack splint versus a dorsal glued splint. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:591-596. [DOI: 10.1007/s00590-018-2349-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/25/2018] [Indexed: 11/26/2022]
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Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118809050. [PMID: 30450008 PMCID: PMC6236480 DOI: 10.1177/1179544118809050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022]
Abstract
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
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Affiliation(s)
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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Sephien A, Schwartz-Fernandes F. An unusual presentation of metacarpophalangeal joint instability of the thumb. Rev Bras Ortop 2018; 53:788-791. [PMID: 30377617 PMCID: PMC6204540 DOI: 10.1016/j.rboe.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/10/2017] [Indexed: 06/08/2023] Open
Abstract
Thumb injuries are not as common as those occurring in the fingers. The authors present the case of a patient who had an isolated avulsion of the extensor pollicis brevis that resulted in metacarpophalangeal joint instability, with intact radial and ulnar collateral ligament.
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Lin JS, Samora JB. Outcomes of Splinting in Pediatric Mallet Finger. J Hand Surg Am 2018; 43:1041.e1-1041.e9. [PMID: 29776724 DOI: 10.1016/j.jhsa.2018.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/07/2018] [Accepted: 03/20/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Excessive flexion at the distal interphalangeal (DIP) joint disrupts the extensor mechanism, leading to mallet finger injuries. The goal of management is to restore active DIP joint extension. We sought to learn which variables (treatment technique, injury type, time to presentation, adherence to treatment) affect clinical outcomes of pediatric mallet finger injuries. METHODS A retrospective review was performed of patients who presented with mallet finger injuries during 2013 to 2017 at a large pediatric hospital. Patient characteristics, treatments, outcomes, and radiographic data were collected. Types of nonsurgical treatment, acute versus delayed (> 28 days) presentation, and compliant versus noncompliant patients were compared. Differences in extension lag and incidence of complications were evaluated. RESULTS There were 94 patients with 99 mallet fingers, with a mean age of 13.7 years, 66 of whom were boys (70%) and 28 girls (30%). Most injuries occurred during recreation (78%). Ninety-nine percent of patients were treated nonsurgically with extension orthoses. The majority of injuries were bony mallets (80%). The outcomes resulted in a mean extension lag of 1°. Of patients presenting acutely, residual extension lag and complications occurred in 12% and 9%, respectively; the lag and complication rate for patients presenting after a delay was 25% and 19%, respectively. Treatment adherence was associated with better clinical outcomes, with nonadherent patients more likely to experience a residual extensor lag (11% vs 67%) and potentially clinically relevant complications (8% vs 50%). CONCLUSIONS The majority of pediatric mallet finger injuries can achieve good outcomes with nonsurgical treatment. Absolute indications for surgery in this population remain unclear. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- James S Lin
- Ohio State University College of Medicine, Columbus, OH
| | - Julie Balch Samora
- Ohio State University College of Medicine, Columbus, OH; Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.
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Sephien A, Schwartz‐Fernandes F. Apresentação incomum de instabilidade metacarpofalângica do polegar. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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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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Lin JS, Samora JB. Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am 2018; 43:146-163.e2. [PMID: 29174096 DOI: 10.1016/j.jhsa.2017.10.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The current literature describes multiple surgical and nonsurgical techniques for the management of mallet finger injuries, and there is no consensus on the indications for surgical treatment. The objective of this study was to determine, through a literature review, if any conclusions can be drawn concerning the indications for surgery in mallet finger injuries; the treatment outcomes of surgical versus nonsurgical management; the most effective methods of surgical and nonsurgical treatment; and the most common treatment complications of mallet finger injuries. METHODS A systematic review of multiple databases was performed. English language clinical studies evaluating therapeutic interventions for mallet fingers that reported objective, standardized outcome measures were included. Basic science studies, cadaveric studies, conference abstracts, level V evidence studies, studies lacking statistical data, and tendinous injuries other than mallet fingers were excluded. Salvage procedures and studies evaluating exclusively chronic lesions were also excluded. RESULTS Forty-four studies that reported clinical outcomes for the treatment of mallet finger injuries, 22 evaluating surgical treatments and 17 studies investigating nonsurgical treatments were included. The average distal interphalangeal joint extensor lag was 5.7° after surgical treatment and 7.6° after nonsurgical treatment. Complication rates of surgical and nonsurgical interventions were comparable (14.5% and 12.8%, respectively). Five studies directly compared the outcomes of surgical with nonsurgical management, with mixed results and recommendations. CONCLUSIONS Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes. Insufficient evidence is available to determine when surgical intervention is indicated. Based on our literature review, it appears that these treatments are equivalent and should be individualized to the patient. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- James S Lin
- The Ohio State University College of Medicine, Columbus, OH
| | - Julie Balch Samora
- The Ohio State University College of Medicine, Columbus, OH; Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.
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Richards T, Clement R, Russell I, Newington D. Acute hand injury splinting - the good, the bad and the ugly. Ann R Coll Surg Engl 2018; 100:92-96. [PMID: 29182002 PMCID: PMC5838697 DOI: 10.1308/rcsann.2017.0195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 11/22/2022] Open
Abstract
Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting. This article aims to provide guidance for frontline staff on the management of hand fractures, with particular emphasis on the appropriate nonoperative care to avoid any unnecessary morbidity.
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Affiliation(s)
- T Richards
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
| | - R Clement
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
| | - I Russell
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
| | - D Newington
- Department of Orthopaedic Hand Surgery, Morriston Hospital , Swansea , UK
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Wang T, Qi H, Teng J, Wang Z, Zhao B. The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury. Sci Rep 2017; 7:11049. [PMID: 28887523 PMCID: PMC5591239 DOI: 10.1038/s41598-017-10959-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/16/2017] [Indexed: 11/09/2022] Open
Abstract
To evaluate the role of high frequency ultrasonography in diagnosis of acute closed mallet finger injury. 36 patients diagnosed with mallet finger were included in this study. All patients underwent ultrasonography, magnetic resonance imaging(MRI) and X-ray examinations. A new kind of classification of acute mallet finger injury based on ultrasonography findings was described. The difference in terms of extensor tendon injury and bony fragment identification ability among the three types of examinations were described respectively. Either an injury of extensor digital tendon or an avulsion fracture of distal phalangeal base was identified clearly on ultrasonography. Among the 36 cases, avulsion fracture of the distal phalangeal base was found without extensor tendon rupture in Type A, complete rupture of the extensor tendon was found without avulsion fracture in Type B, and contusion of the extensor tendon was found in Type C. Compared with X-ray, ultrasonography and MRI could show the extensor tendon injury clearly. While compared with MRI, ultrasonography and X-ray was more sensitive in showing bony fragment. High frequency ultrasonography could be an accurate, reliable, and non-invasive diagnostic imaging method in diagnosis of acute close mallet finger injury.
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Affiliation(s)
- Tiezheng Wang
- Shandong University, Shandong Medical Imaging Research Institute, Shandong, China
| | - Hengtao Qi
- Shandong University, Shandong Medical Imaging Research Institute, Shandong, China.
| | - Jianbo Teng
- Shandong University, Shandong Medical Imaging Research Institute, Shandong, China
| | - Zengtao Wang
- Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Bin Zhao
- Shandong University, Shandong Medical Imaging Research Institute, Shandong, China
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