Bony Mallet Finger Research Articles

Extension pin block technique versus extension orthosis for acute bony mallet finger; a retrospective comparison

PurposeThis 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 methodsThirty-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. ResultsAt 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). ConclusionsConservative 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 evidenceIV; Retrospective cohort.

Reliability of subluxation and articular involvement measurements during the assessment of bony mallet finger

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.

Current methods, outcomes and challenges for the treatment of hand fractures.

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.

A comparison of delta wire technique versus extension block pinning in the treatment of bony Mallet finger.

Sechs Monate postoperativ wurde bei allen Patienten das klinische Ergebnis nach den Crawford-Kriterien, die Schmerzen anhand einer visuellen Analogskale (VAS) und der DASH-Score ermittelt. Zusätzlich wurden die aktive Beweglichkeit und das Extensionsdefizit im Endgelenk sowie aufgetretene Komplikationen festgehalten. Patienten der Gruppe 1 hatten eine signifikant bessere Beugung im Fingerendgelenk, aber auch ein signifikant größeres Extensionsdefizit, obwohl sie signifikant früher ihre Arbeit wiederaufnahmen. Nach den Crawford-Kriterien erzielten 71 % der Patienten der Gruppe 1 und 100 % der Gruppe 2 ein exzellentes und gutes Ergebnis. Keine Unterschiede konnten bzgl. der OP-Dauer, der Schmerzen, dem DASH-Score und der Zeit bis zur knöchernen Heilung festgestellt werden. In der Kurzzeitbeobachtung werden mit Extension-Block-Pinning bessere Ergebnisse in der Behandlung des knöchernen Strecksehnenausriss am Fingerendglied erzielt als mit der Delta-Draht-Technik.

Splinting versus extension-block pinning of bony mallet finger: a randomized clinical trial.

Surgical treatment of bony mallet fingers is frequently recommended, but the evidence is sparse. This randomized clinical trial aimed to compare nonoperative splinting versus extension-block pinning of bony mallet fingers with involvement of more than one-third of the joint surface but without primary joint subluxation. Thirty-two patients were randomized and 28 fulfilled the protocol. At 6months follow-up, there were no significant differences in active extension lag in the distal interphalangeal joint (the primary outcome) or in patient-reported function and pain scores. Flexion and active range of motion in the distal interphalangeal joint and finger-to-palm distance were better in the splinting group, but three patients developed secondary subluxation. We conclude from this study, that splinting these injuries is safe and efficient in restoring joint motion, but splinting does not sufficiently prevent secondary subluxation of the joint. Radiographic follow-up during splinting appears to be necessary. Level of evidence: I.

Causes of Procedural Failures of Closed Reductions using an Extension-Block Pin for Bony Mallet Finger

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.

Mini-Plate and Screw Fixation Technique for Comminuted Flexor Digitorum Profundus Avulsion Fracture

Avulsion fracture of flexor digitorum profundus (FDP) tendon is relatively rare fracture at the distal phalangeal base than avulsion fracture of terminal extensor tendon. Terminal extensor avulsion fracture, known as bony mallet finger, could be successfully treated by closed reduction and pinning, such as extension block technique. However, most of FDP avulsion fracture, known as Jersey’s finger, needed open reduction, because of the proximal migration of fracture fragment and difficulty of pin fixation. Up to date, most of FDP avulsion fractures were treated by open reduction and fixation by pull-out suture or suture anchor technique. We report a case of comminuted FDP avulsion fracture, successfully treated by open reduction and mini-plate and screw fixation technique.

A comparison of single versus double cortical procedure using dorsal Kirschner wire through extension block method in the surgical treatment of mallet finger

Objectives: In this study, we aimed to compare functional and radiological outcomes of single versus double cortical procedure using a Kirschner wire (K-wire) through extension block method (EBM) in the surgical treatment of bony mallet finger. Methods: Between January 2019 and April 2020, a total of 21 patients (13 males, 8 females) who underwent EBM for a bony mallet finger were retrospectively analyzed. The patients were divided into two groups as Group 1 (n=9) and Group 2 (n=12). Surgical treatment was performed using dorsal K-wires through a single cortical line in Group 1 and through a double cortical line in Group 2. Functional outcomes were evaluated using the Crawford’s evaluation criteria. Time to union in the fracture line was compared between the groups. Results: The mean age was 37 (range, 22 to 57) years and the mean follow-up was 11 (range, 8 to 15) months. According to the Crawford’s criteria, the outcomes were excellent in 19 patients and good in two patients. There was no statistically significant difference in the functional outcomes between the groups (p>0.05). Time to complete union was 31 days in Group 1 and 29 days in Group 2 (p=0.06). Radiographic complete union was achieved in both groups. Serous discharge was observed from the entry site of the K-wire in one patient in each group. After one-week oral antibiotherapy, serous discharge resolved. Conclusions: The EBM is an effective and valid method in the treatment of mallet finger, and both the single and double cortical procedures through the dorsal K-wire yield comparable functional and radiographic outcomes.

Extension Block Pinning in Subacute/Late Bony Mallet Finger Injuries

Mallet finger is inability to fully extend a finger due to the disruption of the extensor mechanism integrity at the distal interphalangeal (DIP) joint level. Cases with DIP joint subluxation, and avulsion fractures involving more than 30% of the DIP joint surface are candidates for surgery. Subacute/late cases have poor outcomes. Investigating the success of extension block pinning in subacute/late bony mallet finger cases is aimed. Patient demographics, the rate of DIP joint involvement in plain X-rays, subluxation status of DIP joint, the time between injury and operation, the duration of the operation, complications in post-operative follow-up, extensor lag and healing status of bone were reviewed. Patient outcomes and relation with operative delay and joint subluxation were analyzed. Mean rate of DIP joint involvement of study group was 43.4 ± 6.12%. Half of the study group (n=7) had DIP joint subluxation. Mean time from injury to operation was 29.78±20.4 days. Six patients’ time from injury to operation was longer than 5 weeks. Study group had statistically significant improvement after surgery. Preoperative mean extensor lag was 15.71° ± 7.30° and postoperative mean extensor lag was 5.57° ± 8.89°(p5 weeks) and presence of subluxation did not alter the outcome (p=0.353 and p=0.149, respectively). Extension block pinning technique is a fast, easy-to-apply technique with minimal morbidity. Although it has more limited results in chronic cases, it can be used safely in the majority of cases requiring surgery.

Open reduction and compression with double Kirschner wires for the treatment of old bony mallet finger

BackgroundThe management of old bony mallet fingers is complicated. The aim of the study is to present a new method of open reduction and compression with double Kirschner wires (K-wires) in treating old bony mallet fingers.MethodsThis was a retrospective analysis of patients with old closed bony mallet fingers treated between June 2013 and December 2016. Complications were observed. The range of motion (ROM) of the DIP joints was measured using a protractor. At the last follow-up, anteroposterior and lateral X-ray of the affected finger was performed, the flatness of the articular surface was scored, and the results were graded using Crawford’s criteria.ResultsSeventeen patients were followed up for 8 (6–19) months. The width of the avulsion fracture block accounted for 25–62% of the articular surface of the distal phalanx. Twelve (70.6%) patients had anterior dislocation of the interphalangeal joint. All patients reported healing at the fracture sites. Healing time was 7.6 ± 2.1(5–13) weeks. All patients had incision healing of I/Class A. Lateral X-ray showed 13 and four patients had excellent and good articular surface flatness, respectively. At the last follow-up, no traumatic arthritis was present. Only one patient developed mild pain after surgery (VAS score of 3). Postoperative ROM was 76.5 ± 10.6° (P = 0.0625 vs. healthy side). At the last follow-up, the angle of loss of dorsiflexion was 0–10° (P < 0.0001 vs. baseline). The flexion angle was 50–90° (P = 0.0625 vs. healthy side).ConclusionsOpen reduction and compression with double K-wires is feasible in treating old bony mallet finger.

Observation on the clinical efficacy of modified double Kirschner wire compression and fixation in the treatment of old bony mallet finger

目的 探讨改良双克氏针加压固定治疗陈旧性骨性锤状指的疗效。 方法 自2015年5月至2018年1月，我们对14例陈旧性骨性锤状指患者采用改良双克氏针加压固定治疗，术后根据X线片骨折愈合情况拔出克氏针。 结果 本组所有患者术后均获得随访，时间为6~14个月，平均9个月，骨折愈合时间为8~12周，平均10周，所有病例骨折均愈合，按Crawford法进行功能评定：优10例，良3例，可1例。 结论 改良双克氏针加压固定法是治疗陈旧性骨性锤状指的一种较理想方法。

Delayed Extension Block Pinning in 27 Patients With Mallet Fracture.

Background: Untreated bony mallet fingers can cause an array of problems; therefore, adequate treatment is essential. The primary aim of this study was to determine the patient-reported functional outcome of delayed surgical intervention of bony mallet fingers. The secondary aim was to determine the complication rate of delayed surgical intervention. Methods: In this single-center retrospective cohort study, all consecutive patients treated between 2010 and 2016 at our level 2 regional teaching hospital were included. Inclusion criterion was a bony mallet finger injury (excluding the thumb), presenting >21 days after injury, treated with extension block pinning. Indications for surgery were >2 mm fragment displacement or volar subluxation of the distal interphalangeal joint. Six to 82 months postoperatively, patients completed the Patient-Rated Wrist and Hand Evaluation (PRWHE) by phone. Complications were extracted by chart review. Results: Twenty-seven patients were included, and all completed the PRWHE. Median time to surgery was 35 days (interquartile range [IQR] = 29-42; range = 22-61). Reasons for delay in surgical treatment were patient/physician delay in 24 cases and failed conservative treatment in 3 cases. The median PRWHE score was 0 (IQR = 0-5; range = 0-22.5). After retrospective assessment of the outpatient charts, no early symptoms of malunion or nonunion were found. One patient had a loss of Kirschner-wire fixation, which was corrected. Three patients had an infection that required antibiotic treatment. Conclusions: Delayed surgical management of bony mallet fingers demonstrated adequate functional outcome with minimal complications when compared with prior literature.

Observation on the clinical efficacy of closed reduction and block compression Kirschner wire technique in the treatment of fresh bony Mallet finger

Objective To explore the surgical technique and treatment outcomes of closed reduction and block compression Kirschner wire technique in the treatment of fresh bony Mallet finger. Methods From June 2012 to May 2015, 20 cases of fresh bony Mallet finger were treated with close reduction and Kirschner wire fixation. One Kirschner wire was used to fix the avulsed fracture fragment with elastic block compression and the other wire kept the distal interphalangeal (DIP) joint in extension. The two wires were pressurized each other through the end of the hook. The pressure device between the Kirschner wires was disengaged 3 weeks after the operation. The Kirschner wires were removed 6 to 7 weeks postoperatively. Then the functional exercises were strengthened. Results All the patients obtained anatomical reduction and bony union. The follow-up time ranged from 6 to 24 months with an average of 10.5 months. According to the Patel’s evaluation method, the results were graded as excellent in 11 cases, good in 7 cases and fair in 2 cases. Conclusion The treatment of fresh bony Mallet fractures with closed reduction and block compression Kirschner wire technique is a simple procedure that provides stable internal fixation and good recovery with less complications. Key words: Finger injuries; Treatment outcome; Bony Mallet finger; Kirschner wire

Clinical efficacy analysis of three kinds of surgical treatment for bony mallet fingers

Objective To compare the clinical outcomes of three kinds of surgical treatment for bony mallet fingers, and to explore the appropriate treatment method. Methods From March 2010 to March 2013, 92 cases of bony mallet fingers were treated with Ishiguro method (32 cases), Kirschner wire combined steel wire cross compression (34 cases), reconstruction of extensor tendon insertion with miniature anchor (26 cases) respectively. Results All the patients were follow-up for 4 to 20 months with an average of 9.6 months. According to Patel mallet finger evaluation standard, the results of Ishiguro method group were excellent in 15 cases, good in 12 cases, fair in 4 cases and poor in 1 case, with the excellent and good rate being 84.4%. The results of Kirschner wire combined steel wire cross compression group were excellent in 11 cases, good in 18 cases, fair in 3 cases and poor in 2 cases, with the excellent and good rate being 85.3%. The results of reconstruction of extensor tendon insertion with miniature anchor group were excellent in 10 cases, good in 12 cases, fair in 3 cases and poor in 1 case, with the excellent and good rate being 84.6%. Conclusion There were no significant differences in the clinical efficacy of the three surgical methods for bony mallet fingers. Considering the fracture classification of the mallet fingers, the proficiency of the doctors and the economic ability of the patients, reasonable selection of suitable operation method is the key to the successful treatment of bony mallet fingers. Key words: Tendon injuries; Fracture fixation,internal; Bony mallet finger

Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

A comparative study of three kinds of surgical methods for treatment of bony mallet fingers

Objective To explore the clinical efficacy of Kirschner wire back compression, elastic fixation and double clips in the treatment of bony mallet fingers and to evaluate the three kinds of surgical methods. Methods From June 2011 to May 2016, 96 patients with fresh closed bony mallet fingers were treated by the methods of Kirschner wire back compression (group A), elastic fixation (group B) and double clips (group C). According to Wehbe and Schneider classification, 37 cases were typeⅠa, 28 cases were typeⅠb, 19 cases were typeⅡa, and 12 cases were typeⅡb. The indications, postoperative complications, fracture healing time and treatment effects of the three methods were compared. Results Postoperative primary healing was achieved in all the patients. The follow-up period ranged from 6 to 32 months with an average of 15.6 months. The X-ray film showed that all the fractures healed at the last follow-up. The average healing time was (6.0±0.6) weeks in group A, (5.6±0.7) weeks in group B, and (5.7±0.5) weeks in group C. According to the evaluation of TAM system, the excellent and good rate was 86.2% in group A, 92.3% in group B and 92.0% in group C. Conclusion Each of the three operation methods has advantages and disadvantages. There are differences in the operation indications, postoperative complications and fracture healing time. Their clinical effects are equivalent, and can achieve satisfactory results in the treatment of bony mallet fingers. Key words: Comparative effectiveness research; Internal fixators; Bony mallet fingers; Kirschner wire

Modified Ishiguro method for treatment of bony mallet finger

目的 探讨改良石黑法治疗骨性锤状指的临床疗效。 方法 自2014年2月至2015年8月，我们对10例伴有末节基底撕脱骨折的锤状指患者，采用改良石黑法治疗，术后6周拔除克氏针。随访患指远指间（DIP）关节屈伸活动范围及X线片表现，按Crawford功能评定方法评定。 结果 术后所有患者均获得随访，时间为3~12个月，平均10个月，无针道感染、皮肤坏死、指甲畸形、疼痛及关节炎等并发症发生。按Crawford功能评定方法评定：优5例，良4例，可1例。 结论 改良石黑法是治疗撕脱骨折块超过关节面1/3的骨性锤状指较为理想的方法，手术操作简单、疗效可靠、并发症少。

Clinical application of tension band technique in the treatment of bony mallet finger

目的 探讨切开复位张力带固定末节伸肌腱止点撕脱骨折的治疗效果。 方法 自2013年8月至2016年3月，我们采用切开复位张力带固定末节伸肌腱止点撕脱骨折患者18例，术后6~10周复查，根据X线片示骨折愈合情况，在局部麻醉下切开取出钢丝，进行康复锻炼。 结果 本组18例患者骨折块均解剖复位或接近解剖复位，骨性愈合，骨折愈合时间为6~10周，平均8.2周。术后随访时间为3~15个月，平均6个月。患指功能按总主动活动度（total active movement，TAM）系统评定方法评定：优12例，良4例，可2例。 结论 切开复位张力带固定末节伸肌腱止点撕脱骨折是一种可行的治疗方法，临床效果较满意。

Simultaneous Bony Mallet Fingers of Two Phalanx in a Patient: A Rarely Seen Case Report

Mallet finger deformity is a common hand injury and usually occurs after a direct impact of sudden and extreme trauma forcing the distal interphalangeal Mallet finger deformity is a common hand injury and usually occurs after a direct impact of sudden and extreme trauma forcing the distal interphalangeal joint to get flexion with an extended proximal interphalangeal joint. Deformity is especially associated with ball use disrupting the extensor mechanism at the base of distal phalanx. Mallet finger deformity in acute stage can be treated by immobilization of distal interphalangeal joint with hyperextension splints. But the surgery becomes the choice in delayed cases and if there is a fracture including more than one third of articular surface of distal interphalangeal joint or distal phalanx volar subluxation. In the literature there are great sum of studies including mallet finger deformities as simultaneous, bilateral or multiple variations and treatment strategies. But in the literautre there is no study about simultaneous bony mallet fingers deformity reported. Here, we present the case of a 30 year old female with simultaneous bony mallet fingers in the third and fourth ray and the conservative treatment of with splinting for six weeks. At the last time follow up the patient was able to use her hand without any diffuculty and she had full range of motion of distal interphalangel joint.

Kirschner wire tension traction combined with steel wire compression in the treatment of bony mallet fingers

目的 探讨克氏针张力牵引联合钢丝加压治疗骨性锤状指的临床疗效。 方法 自2013年4月至2015年5月，我们对30例骨性锤状指患者采用克氏针张力牵引联合双钢丝交叉加压治疗。术后患指近指间关节无需外固定，6 ~ 8周后拔除克氏针，对远指间关节的屈伸活动范围及X线片进行评价。 结果 术后2例失访，28例获得随访，时间为5 ~ 18个月，平均9个月，伤口均Ⅰ期愈合，X线片示撕脱骨块均已解剖复位并愈合。采用Dargan功能评定：优19例，良6例，可3例，优良率为89.3%。 结论 采用克氏针张力牵引联合钢丝加压治疗骨性锤状指，手术操作简单，临床效果较为满意。