Hook Plate Technique Research Articles

Efficacy of allogeneic tendon material coracoclavicular ligament reconstruction combined with Kirschner wire and titanium alloy hook plate material fixation in the treatment of acromioclavicular joint dislocation.

To compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation. From January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi 'an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups. All 43 patients were followed up for an average of 9.7 (9-12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group. The clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients.

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.

The Results of Hook Plate Fixation for Palmar Fracture Dislocation of the Proximal Interphalangeal Joint

This study aimed to present the clinical outcomes of the dorsal plating technique for palmar fracture dislocations of the proximal interphalangeal (PIP) joint. This plating technique minimizes dissection and interference with the finger extensor mechanism. We treated seven patients (with a mean age of 39.1 years) with dorsal hook plates for palmar fracture dislocations of the PIP joint between April 2018 and August 2022. The little finger was affected in five patients, and ring finger was affected in two. The mean time to surgery was 5.6 days, and the postoperative follow-up period was seven months. On the second postoperative day, all patients were allowed active motion of both the PIP and the distal interphalangeal (DIP) joints. Simultaneously, DIP blocking exercises were started to prevent adhesion of the extensor mechanism. The mean active flexion and extension of the PIP joint was 105° and-4°, respectively, whereas those of the DIP joint were 65° and 4°. No patient experienced extension lag in the DIP joint. The mean total active motion (TAM) was 273°, and the %TAM was 96%. The grip strength of the affected hand averaged 90% of that of the unaffected hand. The mean numerical rating scale for pain was 0.3 points, and the mean Hand20 score was 5.1 points. No complications were observed; two patients underwent implant removal at their request. The present study suggests that this hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints. Therapeutic V.

Comparison of Two Different Implants in Medial Malleolus Fracture.

We compared two different techniques used in medial malleolus fracture. It has been hypothesized that the hook plate technique, which has become widespread in recent years, may have an advantage over cannulated screws. Preoperative and postoperative data for medial malleolus fractures operated on between 2010 and 2020 were analyzed retrospectively. Patients were divided into those operated on with a hook plate (n = 20) and those operated on with compression screws (n = 20) and were compared in terms of complications, pain, functional recovery, union success, and ankle joint range of motion. Fracture union times were recorded. Between groups, there were no significant differences in time to fracture union, pain, range of motion, and American Orthopaedic Foot and Ankle Society score (P = .420). Handling of the implant in a very weak patient in the hook plate group and revision in the cannulated screw group were the differences in complications between groups. The use of hook plates in a patient with medial malleolus fracture with metaphyseal fracture provided significant convenience in osteosynthesis. Use of hook plates provides serious advantages to the surgeon in medial malleolus fractures with small or fragmented fragments and combined with malleolus metaphyseal fractures. Having a larger implant versus a cannulated screw is seen as a disadvantage, but screwing the implant close to the cortex increases its strength. Therefore, its use should be given priority in patients who are mentally unable to weightbear after surgery. Although hook plate is advantageous compared with cannulated screw in appropriate indications, it can be used safely in all malleolus fractures where cannulated screws are used.

Long-term Results of Hook Plate Technique in Acromioclavicular Joint Dislocations

Long-term Results of Hook Plate Technique in Acromioclavicular Joint Dislocations

Comparison of the Hook Plate versus TightRope System in the Treatment of Acute Type III Acromioclavicular Dislocation

The objective of this study is to compare the effectiveness of the clavicular hook plate (HP) technique and the minimally invasive coracoclavicular (CC) fixation with a TightRope (MITR) procedure in treating acute unstable distal clavicle dislocation. MITR (minimally invasive TightRope) group had 21 patients, and the open reduction and internal fixation (HP) group included 23 patients. Researchers compared MITR and HP (hook plate) outcomes for the treatment of acute type III AC joint dislocation in a retrospective analysis. The patients were followed up at 1 3, 6, and 12 months postoperatively. Complications were analyzed such as redislocation, fractures, implant-related complications, or subacromial erosion. For the clinical outcomes, the visual analog scale (VAS) (0: no pain, 10: worst possible pain), Constant-Murley score (CMS) (100: no pain, 0: maximum pain), the average satisfaction score with their current shoulder function (range: 0-10), and the University of California at Los Angeles Shoulder score (UCLA) (>27 good/excellent <27 fair/poor) were recorded at the last follow-up. There were 21 sufferers in the MITR group, which comprises 19 males and 2 females and 23 individuals in the HP group (20 men and 3 women), with average ages of 43.9 and 39.2, respectively. Age, sex, laterality, and the interval between injury and surgery did not significantly differ between the two groups (0.357, 0.792, 0.432, and 0.55, respectively). No statistically significant difference was found between the groups in terms of the VAS score and CMS score at one year postoperatively. The mean CCD at the initial trauma and last follow-up was not significantly different between the MITR and HP groups (p=0.365, p=0.412 respectively). For treating acute type III AC dislocations, the minimally invasive TightRope (MITR) system and the hook plate technique were great options. However, the minimally invasive TightRope system showed further benefits such as reduced reoperation for implant removal and reduced risk of subacromial distal clavicle osteolysis.

Primary Results of Hook Plate Fixation Technique for Ulnar Collateral Ligament Fracture-Avulsion: A Case Study.

Ulnar collateral ligament(UCL) fracture-avulsion of the thumb which involves small osseous fragments is among common injuries to the thumb metacarpophalangeal (MCP) joint. This case series was conducted on 11 patients (9 males and 2 females) with a mean age of 25.4±4.8 years with acute traumatic UCL fracture-avulsion with instability and Stener Lesion. A low-profile 2-mm stainless steel hook plate with a 2-mm screw was used for the internal fixation. Immobilization was performed for 10 days. Range of motion movements (ROM), grip power, and pinch strength were measured after three months. At the end of the follow-up period, functional outcomes were determined by the visual analog scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH). The mean follow-up period was reported as 12.4±2.3 months. the union of avulsed small osseous fragments occurred at the end of the three-month follow-up. A number of 10 patients were treated by one hole 2-mm plate with a screw and a mean VAS score of 22.5±2.4, while a female patient had more severe pain with a mean score of 45. This patient complained about the irritation of the plate, especially in the thumb grip. The mean Quick DASH score was 9.6±1.4. The postoperative ROM was similar to that of the other side. Grip power and pinch strength were lower in the treated thumb, as compared to that in the opposite side; nonetheless, the difference was not statistically significant. As evidenced by the obtained results, it can be concluded that the hook plate technique is a strong fixation method for thumb UCL fracture-avulsion, raising the possibility of earlier joint movements and rapid recovery; nevertheless, in some cases, it can reduce efficiency and induce painful grip.

Tightrope and Clavicular Hook Plate Technique: A Commentary

Although acromioclavicular joint dislocations are relatively common as the sequelae from trauma or sports related injuries, more severe injuries requiring surgical treatment often remain scarce [1]...

Comparison of the Radiological and Functional Results of Tight Rope and Clavicular Hook Plate Technique in the Treatment of Acute Acromioclavicular Joint Dislocation

Purpose/Aim: Options for surgery for acromioclavicular (AC) joint dislocation vary considerably. This study aimed to examine the functional and radiological results of patients who were operated on using the tightrope (TR) or clavicular hook plate (CHP) technique in the treatment for AC joint dislocation. Materials and methods: The data gathered from 35 consecutive patients who were operated on for AC joint dislocation were analyzed retrospectively in terms of their radiological and functional outcomes. Results: Thirty-two (91.4%) of the 35 patients were male and 3 (8.6%) were female. Thirty (85.7%) patients were classified as Rockwood type 3 and 5 (14.3%) as type 5. Twenty-one patients operated on using the TR technique were categorized as group 1, and 14 patients treated with the CHP technique formed group 2. Functional results were evaluated using the Constant–Murley shoulder scoring system; no statistically significant difference was observed between type 3 and 5 AC separation (p = 0.337). The mean Constant scores of type 3 and 5 injuries were 82.96 and 88.6, respectively. A significant relationship was noted between reduction quality and functional scores (p = 0.006). Postoperative osteoarthritis was seen in 12 (57.14%) patients in group 1 and 7 (50.00%) patients in group 2. In terms of surgery duration, 50.57 minutes in group 1 and 35.71 minutes in group 2 were noted. A statistically significant difference was found between the two groups in terms of surgery duration (p < 0.05). Conclusions: TR and CHP techniques, which do not differ significantly in terms of their clinical results, can be used safely in the treatment of AC separation.

To explore the reasonable selection of clavicular hook plate to reduce the occurrence of subacromial impingement syndrome after operation

BackgroundAcromioclavicular joint dislocation is a shoulder joint injury common in the clinical setting and is generally surgically treated with clavicular hook plate technique with confirmed curative effect. However, symptoms such as shoulder abduction limitation, shoulder discomfort and joint pain postoperatively may occur in some patients. Therefore, this study aimed to explore whether the existing clavicular hook plate can be reasonably selected to reduce the incidence of subacromial impingement syndrome (SIS) and provide a reference for clinical diagnosis and treatment.Materials and methodsPatients with SIS admitted from March 2018 to June 2020 were selected as the experimental group and asymptomatic patients postoperatively, as the control group. The hook end depth and acromial height of the hook plate used in patients were recorded, and the difference between them was calculated.ResultsThe difference between the hook plate depth and acromial height was 7.500±1.912 mm and 6.563±1.537 mm in the experimental and control groups, respectively, with statistically significant difference (t=3.021, P=0.006). A difference of >0.6 mm as a grouping index is required to perform a single factor analysis, with statistically significant difference (t=3.908, P=0.048).ConclusionsThe occurrence of SIS after placing the clavicular hook plate may be related to the difference between its depth and the acromial height. A difference of >6 mm may be a factor affecting the occurrence of SIS. Pre-imaging measurement of the acromial height can provide suggestions for selecting the type of hook plate intraoperatively.

Hook Plate Fixation of Medial Malleolar Fractures

Ankle fractures are common injuries treated by orthopedic surgeons. Medial malleolar fractures, occurring in isolation or in combination with lateral or posterior malleolar fractures, usually require surgical fixation if there is any amount of fracture displacement. With the recent advancement in surgical techniques, many different methods of fixation have been described in the literature from cannulated screws to sled devices. The objective of this study is to describe the hook plate technique for open reduction and internal fixation of medial malleolar fractures and present outcomes in 2 patients who underwent this procedure. Hook plate fixation of medial malleolar fractures results in acceptable outcomes and is be a good alternative to traditional methods of fixation in patients.

Reconstruction of coracoclavicular ligament combined with hook plate technique for treatment of distal clavicle fractures involving avulsion of coracoclavicular ligament

Objective To explore the operative strategy of distal clavicle fracture involving coracoclavicular ligament. Methods Data of 17 cases of distal clavicle fracture involving coracoclavicular ligament in our hospital from January 2013 to December 2018 were analyzed retrospectively. According to whether the coracoclavicular ligament was reconstructed or not, the patients were divided into two groups: non reconstruction group (10 cases), male (7 cases), female (3 cases), 19-60 years old (37.9±11.9). In the reconstruction group, 7 cases were male 5, female 2, 25-62 years old (44.9±13.0). Three dimensional CT was used to judge the ligament injury and X-ray was used to evaluate the fracture reduction and healing after operation. The time of fracture healing was compared between the two groups. The function of shoulder joint was evaluated by visual analog scale (VAS) and Constant score of shoulder joint. Results The patients in both groups were followed up for (18.7±6.7) months (range, 9-27 months). At the latest follow-up, the time of fracture healing in the reconstruction group was 12.6±0.7 weeks (range, 12-14 weeks); VAS score was 3.0±1.3 and Constant-Murley score was 85±11. While those in the non reconstruction group were 23.7±7.9 (range, 16- 48 weeks), 3.1±1.8 and 77±10 respectively. The time of fracture healing was statistically significant (t=3.361, P=0.004). There was no significant difference in VAS score and Constant score (P> 0.05). In the non reconstruction group, there were 1 case of delayed union of fracture (healed 48 weeks after operation), 1 case of loosening of clavicular hook plate, 5 cases of acromioclavicular joint dislocation (Rockwood type II) after removal of internal fixation, and the overall complication rate was 70% (7/10). Reconstruction group: 1 case of acromial fracture, the overall complication rate was 14.3% (1/7). There was significant difference between the two groups (χ2=5.13, P=0.024). Conclusion Reconstruction of clavicular insertion of coracoclavicular ligament can effectively reduce the postoperative complications of distal clavicular fracture involving the coracoclavicular insertion. Attention should be paid to the repair and reconstruction of coracoclavicular ligament injury during fracture treatment. Key words: Clavicle; Fractures, bone; Ligaments

Clavicle Hook Plate Technique and Functional Results in the Treatment of Acromioclavicular Joint Dislocation

Aim: The aim of this study was to evaluate the functional results of patients with acromioclavicular joint (ACJ) dislocation and who were treated surgically with Hook plate (HP) .Patients and Methods:Patients with ACE dislocation between the years of 2016- 2018 and treated surgically with clavicle KP technique were included in the study. Of the 19 patients, 17 were male and 2 were female. 13 patients had Rockwood Type IV joint dislocation and 6 patients had Rockwood Type V joint dislocation. Functional results were evaluated with modified Constant-Murley shoulder score and standard test protocol. Descriptive statistics were used for data analysis.Results: The plate was removed at 10 months after the operation due to severe pain and limitation of movement in 1 patient. Two of the patients had plate dislocation. Other patients had no complaints. Degenerative changes were detected in direct radiography in 2 patients. The mean Modified Constant-Murley Shoulder Score of the patients was 65 (min: 26, max: 84). The mean pain score of the patients was 7. Ten (53%) patients had moderate and severe pain. Four of the patients had pain at the severity of 8, 4 of the patients had pain at the severity of 10, and 2 of the patients had pain at the severity of 12. The mean daily life activity score of the patients was 12 (min: 6-max: 20). The flexion and abduction score of the patients were lower than the external rotation and internal rotation. The mean total motion score of the patients was calculated as 27 (min: 8-max: 36).Conclusion: The HP method in the treatment of ACJ dislocation is early movement and load can be given, surgery is short and easy to apply as a method. However, it causes moderate and severe pain. This may affect functional results.

Suture Button Versus Hook Plate for Acute Unstable Acromioclavicular Joint Dislocation: A Meta-analysis

Background: Surgical treatment is indicated for unstable acromioclavicular (AC) joint dislocation. The hook plate (HP) technique is a commonly used treatment method, but the use of the suture button (SB) technique is increasing. Purpose: To conduct a meta-analysis of clinical studies evaluating patient outcomes between the SB and HP techniques for acute unstable AC joint dislocation. Study Design: Meta-analysis. Methods: A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies comparing the SB and HP procedures for acute unstable AC joint dislocation were included. Statistical analysis was performed with RevMan (v 5.3.5). Results: Eight clinical studies that met the inclusion criteria were identified and included a total of 204 patients treated with the SB technique and 195 patients with the HP technique. Patients treated with the SB technique had a higher Constant score (mean difference [MD], 3.95; 95% CI, 1.20-6.70; P = .005) and a lower visual analog scale pain score (MD, –0.75; 95% CI, –1.12 to 0.37; P < .0001) when compared with the HP technique. No significant differences in operation time (MD, –0.38; 95% CI, –7.14 to 6.37; P = .91), coracoclavicular distance (MD, –0.07; 95% CI, –0.49 to 0.35; P = .75), complications (odds ratio, 0.59; 95% CI, 0.22-1.54; P = .28), and loss of reduction (odds ratio, 2.55; 95% CI, 0.66-9.83; P = .17) were found between the SB and HP techniques. The subgroup analysis showed that the arthroscopic SB technique resulted in a higher Constant score (MD, 6.75; 95% CI, 4.21-9.29; P < .00001) as compared with the HP technique, but no differences were observed between the open SB and HP techniques (MD, 0.69; 95% CI, –0.82 to 2.20; P = .37). Conclusion: This meta-analysis demonstrated that the SB technique resulted in better functional outcomes and a reduced visual analog scale pain score when compared with the HP technique. However, for operation time, coracoclavicular distance, complications, and loss of reduction, there were no statistically significant differences between the techniques. Compared with the open procedure, arthroscopic SB may be superior for better functional outcomes.

Outcome of Hook Plate Fixation of Mallet Fractures.

Hook plate fixation of closed mallet fractures was first described in 2007, but there has subsequently been a lack of studies examining the outcomes and complications of this technique. This paper aims to assess the clinical outcomes of hook plate fixation of closed mallet fractures by retrospectively reviewing 31 closed, bony mallet injuries that were surgically fixed with a hook plate between 2002-2011. Patients who underwent hook plate fixation had a median time to radiographic union of 83 days. Pre-operative median distal interphalangeal joint (DIPJ) extensor lag was 20°, with a post-operative extensor lag of 0°. Median DIPJ flexion was 60°, with 58% of all cases achieving greater than 50° of DIPJ flexion. There were 4 instances of minor complications (i.e. transient nail deformity and marginal skin flap ischaemia), with 3 cases of major complications (i.e. fracture redisplacement). Our results show that the hook plate technique has satisfactory functional outcomes and an acceptable complications rate compared to other treatment modalities in the existing literature. Nevertheless, the outcomes of this technique in our sample population were not as excellent as initially reported. Level IV: Retrospective case series, Therapeutic Studies.

Comparing the coracoclavicular loop technique with a hook plate for the treatment of distal clavicle fractures

Treatment of displaced distal clavicular fractures is still controversial. This study reports the utility of a new coracoclavicular (CC) loop technique for acute displaced distal clavicular fractures and compared its surgical outcomes with those of the hook plate method. In this retrospective study, a total of 23 patients with acute displaced distal clavicular fractures were treated with a new CC loop technique at a single institution from 2010 to 2014. Another group comprising 49 patients treated with a hook plate was compared with the CC loop group regarding clinical and radiologic outcomes. Seventy-two patients with at least 1 year of follow-up after both operations were included in this study. The Constant score was significantly greater in the CC loop group (95 vs 87, P = .009) at final follow-up. Moreover, the complication rate was significantly lower in the CC loop group (0% vs 24.5%, P = .007). The University of California, Los Angeles shoulder score and radiologic nonunion rate revealed no significant differences between the 2 groups. The new CC loop technique had better clinical outcomes and lower complication rates compared with the hook plate technique.

Clavicle hook plate technique and its functional results in the treatment of acromioclavicular joint dislocation

AMAC: Akromiyoklavikuler eklem cikiginin cerrahi tedavi secenekleri oldukca ceșitlilik gostermektedir. Biz bu yazimizda Tip 3 ve Tip 5 akromiyoklavikuler eklem cikiklarinda klavikula cengel (hook) plagi uyguladigimiz olgulari ve fonksiyonel sonuclarini incelemeyi amacladik. YONTEM: Bu retrospektif calișmada, ayni teknikle ameliyat edilmiș 24 hastanin verileri incelendi. Veri analizinde, ozellikler tanimlayici istatistiklerle sunuldu. BULGULAR: Inceledigimiz 24 hastadan 20’si erkek ve dordu kadindi. Akromiyoklavikuler eklem cikigi olgularin 11 tanesi Rockwood Tip 3, 13 tanesi Rockwood Tip 5 eklem cikigiydi. Tum hastalar klavikula cengel plagi teknigi ile tedavi edildi. Hastalar ortalama 27,6 ay (6 ay–50 ay) takip edildi ve takip direkt grafi ile yapildi. Fonksiyonel sonuclar Constant-Murley omuz skorlamasi ile degerlendirildi. Bir hastada enfeksiyon nedeni ile ameliyat sonrasi beșinci ayda, bir hastada ise hareket kisitliligi nedeni ile ameliyat sonrasi ucuncu ayda plak cikartildi. Bir olguda ise plagin cengel kisminin kirilmasi nedeni ile ameliyat sonrasi 13. ayda plak cikartildi. Diger hastalarda șikayet olmadi. Dort olguda direkt grafide dejeneratif degișiklikler saptandi. Constant-Murley omuz skorlamasi 20 hastada mukemmel (%83,3) ve dort hastada iyi (%16,7) olarak saptandi. SONUC: Akromiyoklavikuler eklem cikigi cerrahi tedavisinde klavikula cengel plagi yontemi cerrahi acidan kolay uygulanabilen, implant cikartilmasina nadiren ihtiyac duyulan ve fonksiyonel sonuclar acisindan bașarili bir yontem gibi gozukmektedir

Treatment of Mallet fractures with internal fixation using hook plate technique

Objective To introduce the surgical techniques and clinical outcomes of trestment of Mallet fractures using hook plate internal fixation. Methods From August 2006 to February 2008, 25 cases of Mallet fractures were treated with hook plate internal fixation. There were 18 cases of Ⅰ B type fractures and 7 cases of Ⅱ B type fractures. Open reduction and internal fixation was performed using a one-hole hook plate fabricated from a 2.0 mm Medicon straight plate. Early postoperative protected motion of the distal interphalangeal (DIP) joint was allowed. Results All the cases were followed up for 2 to 18 months, with an average of 10 months. All the fractures healed successfully, with an average bone union time of 5 weeks. Functional evaluation included degree of pain and DIP joint flexion and extension. The results were rated as excellent in 14 cases, good in 9 cases, fair in 2 cases and poor in 0 case. The overall good-excellent rate was 92%. There were no postoperative complications. Conclusion Treatment of Mallet fractures with hook plate internal fixation technique can achieve more tellable fixation than conventional methods. This technique avoids placing implants or wires through the small avulsion fragment and the DIP joint while still being able to achieve a stable fixation construct strong enough to allow protected early active motion of the DIP joint. In minimizing the need for prolonged sprinting, patient comfort is also improved . It is an effective method for treatment of Mallet fractures involving more than one-third of the base of the distal phalanx. Key words: Fracture fixation; Internal fixators; Mallet fractures

Technical Note: Hook plate fixation of FDP avulsion fractures

FDP avulsion fractures are complex injuries that frequently present late and are difficult to treat. Many surgical approaches to fixation are described. The authors describe a novel technique for fracture fixation that is used in their hand unit. BACKGROUND Avulsion fractures of flexor digitorum profundus were classified by Leddy and Packer. The injury is frequently missed and presentation may therefore be delayed. The injury is difficult to treat and reconstructive options include screw fixation of the fracture, Mitek anchor reattachment and use of pull through sutures through the distal phalanx with a button on the nail plate. AIMS To assess the outcome of fracture fixation using a new hook plate devised in our unit. METHODS The avulsed tendon is explored using a traditional volar Brunner incision (Figure 1). The fracture site is cleared of debris and reduced. An off-cut 3-hole section of a 1.5mm AO / Synthes compact hand reconstruction plate is fashioned into a hook plate after cutting through the last hole and bending the two halves through 90 degrees into hooks (Figure 2a and b). The plate is contoured and then the hooks are used to grasp the flexor tendon just proximal to the fracture. The plate is fixed to the distal phalanx with a single bicortical 1.5 mm screw passed from distal to proximal to avoid the germinal matrix of the nail on the dorsum. Images are taken with the mini C-Arm (Figure 3a and b) and the wound is closed (Figure 4). Post-operative extension block splintage is performed for 3 weeks followed by 3 weeks in a mallet splint. Resisted power grip is avoided for 6 weeks. Figure 1 Figure 1 Figure 2 Figure 2a and b Technical Note: Hook plate fixation of FDP avulsion fractures 2 of 3 Figure 3 Figure 3a and b Figure 4 Figure 4 RESULTS The fracture reduction is maintained and congruent union of the intra-articular fragment is achieved. Patient satisfaction is high and early mobilisation allows good return of distal interphalangeal joint movements. No nail growth disturbance is reported. DISCUSSION The flexor digitorum profundus avaulsion fracture is difficult to treat. The Birmingham Hook Plate offers a better biomechanical fixation than a single screw or Mitek anchor. The infective complications of a pull-through suture are avoided. CONCLUSION The hook plate technique is a reliable method of fixation of these difficult avulsion fractures.

Use of a hook plate technique in the management of proximal ulna fractures

Use of a hook plate technique in the management of proximal ulna fractures