Mallet fractures: a prospective comparison of treatment outcomes

Jessica A Savage,Shirley Collocott,Devlin Elliott,Clara Miller,Karen Smith

doi:10.34239/ajops.v4n1.222

Abstract

Background: The optimal management of mallet fractures is controversial. Currently, published evidence does not clearly define the role of surgery in managing these fractures or identify when splinting alone is suitable.Methods: An observational, prospective cohort study was undertaken between 2012 and 2015 evaluating patient experience, and radiological and functional outcomes following mallet fractures managed with splinting alone or surgery combined with post-operative splinting. This study was registered with our local research facility and ethical approval was granted by the New Zealand Northern B Health and Disability Ethics Committee Health and Disability Ethics Committee (HDEC) #13/NTB/202. All patients provided formal written consent. Results: A total of 109 adult patients with 113 mallet fractures were enrolled in the study and 85 patients with 89 fractures completed follow-up. Mean follow-up was 190 days. Fractures initially associated with subluxation of the distal interphalangeal (DIP) joint treated with splinting alone were five times more likely to fail to meet a minimum standard of success than those fixed with surgery. When the fracture fragment occupies between one and two thirds of the joint surface, even in the absence of initial DIP joint subluxation, 13/35 (37%) joints subluxed during splint treatment. Conclusion: This study aids clinicians by highlighting where splinting is likely to fail and providing a means of identifying injuries in which surgery must be considered

Highlights

Mallet fractures are caused by avulsion of the extensor tendon from the distal phalanx and may be associated with distal interphalangeal (DIP) joint subluxation
Mallet fractures range in severity from small, minimally displaced avulsions with enlocated joints to large, displaced fracture fragments with associated joint subluxation.[1,2]
The purpose of this study is to provide a patientfocused, multifaceted assessment of surgical and non-surgical treatment of acute mallet fractures

Summary

Introduction

Mallet fractures are caused by avulsion of the extensor tendon from the distal phalanx and may be associated with distal interphalangeal (DIP) joint subluxation. Mallet fractures range in severity from small, minimally displaced avulsions with enlocated joints to large, displaced fracture fragments with associated joint subluxation.[1,2] The Wehbé and Schneider classification for bony mallet injuries assigns a number to reflect joint subluxation and a letter to reflect the percentage of joint surface involved (Figure 1).[3,4]. Various surgical techniques have been described in mallet fracture treatment. Ishiguro first described the closed extension block pinning technique, which adds a second blocking K-wire, a technique modified by other authors since.[5,6] Alternatively Kronlage, Teoh and Theivendran have all illustrated open reduction and internal fixation with screws or a plate.[7,8,9]. The optimal management of mallet fractures is controversial. Published evidence does not clearly define the role of surgery in managing these fractures or identify when splinting alone is suitable

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