Mallet Finger Fractures Research Articles

The biomechanical properties of the hook plate and pull-out suture in mallet finger fractures: a cadaveric study.

A total of 32 cadaveric fingers with bony mallet injuries were fixed using either the hook plate or the pull-out suture technique. The purpose of this study was to assess the immediate postoperative biomechanical responses of the fixation techniques under different load conditions. The fingers were cyclically loaded with a force of 7 N for 3500 cycles and until construct failure. The maximum displacements of the hook plate and pull-out sutures were 0.7 mm and 0.6 mm, respectively (p = 0.556). The stiffnesses of the hook plate and pull-out suture were 1.3 N/mm and 1.1 N/mm, respectively (p = 0.515). The ultimate loads-to-failure for the hook plate and pull-out suture were 64.4 N (interquartile range [IQR] 37.7-77.7) and 44.5 N (IQR 29.7-63.5), respectively (p = 0.094). Both fixation techniques were able to withstand immediate postoperative mobilization without any difference in fracture displacement, construct stiffness or maximum load to failure.

Modeling and Analysis of Finger Splint for Mild to High-Grade Mallet Finger Fracture

Modeling and Analysis of Finger Splint for Mild to High-Grade Mallet Finger Fracture

Extension block pinning combined with traction using towel clamps for effective reduction of mallet fracture: a technical tip

Purpose: Although closed reduction and extension block pinning have been widely used for acute mallet finger fracture, the problem of reduction remains a concern. We describe a tip for the reduction technique using a towel clamp, which provides a longitudinal traction force to the distal phalanx, and report the results of the technique.Methods: The medical records of 14 consecutive cases from 12 patients with acute mallet fractures were retrospectively reviewed. Reduction was achieved using the towel clamp reduction technique. The radiologic results were evaluated by simple radiographs, the functional results were analyzed in terms of range of motion, and remaining pain was assessed using Crawford criteria.Results: The mean follow-up period was 8.4 months. The mean union duration was 6 weeks. The mean range of motion was 73°. Eight cases had excellent outcomes, one had good outcomes, four had fair outcomes, and one had poor outcomes. One case of superficial infection and one case of skin necrosis developed, and three cases showed arthritic changes in the distal interphalangeal joint.Conclusion: The towel clamp technique can provide good reduction during surgery, with favorable radiologic and clinical results.

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures

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. 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. 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. 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. Therapeutic IV.

Surgical treatment of the bony mallet thumb: a case series and literature review

IntroductionThe aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method.Patients and methodsAll patients (n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb (n = 21 articles).ResultsSurgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. An open reduction led to worse functional scores compared to a closed reduction. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods.ConclusionThe evidence for the best treatment of a bony mallet thumb fracture is low. On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.

Extension Block Pinning Vs Single Kirshner Wiring To Treat Bony Mallet Finger. A Retrospective Study.

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.

A Trial of the Effect of 2-Step Orthosis Treatment for Mallet Finger Fractures.

Many patients report poor therapeutic outcomes following mallet finger fracture surgery. A more reliable technique is urgently needed. To present a novel treatment for mallet finger fractures using a 2-step orthosis method. Prospective, observational study. Hospital. Patients with mallet finger fractures. The finger is fixed with splints for 6 weeks, including 3 weeks for the proximal interphalangeal joint in the flexion position and the distal interphalangeal joint in the hyperextension position (first splint) and 3 weeks for the distal interphalangeal joint in the hyperextension position (second splint). Up to week 8, the second splint was attached at night and during physical exertion. Crawford criteria, Abouna-Brown criteria, bone fusion, grip strength, Doyle classification, Ishiguro classification. Sufficient bone fusion was achieved 12 weeks after fixation; at which time, the range of motion with the distal interphalangeal joint flexed, and extended in the 3 patients was 50° and 0°, 70° and -3°, and 60° and 0°, respectively. The right and left hand grip strengths in the 3 patients were 58 and 55kg, 62 and 58kg, and 31 and 29kg, respectively; there were no problems with respect to function or work. The first 2 patients could start sports again with partial return after 1 week and complete return after 12 weeks and 8 weeks, respectively. For the third patient, rehabilitation was complete after 16 weeks. Evaluation of the fracture sites based on the Crawford criteria showed the condition to be perfect, and evaluation based on the Abouna-Brown criteria showed success. This method provides satisfactory fixation and can prevent proximal interphalangeal joint contracture. Favorable long-term outcomes were confirmed in all patients, suggesting that this method may be effective for previously untreated mallet finger fractures with little displacement.

Conservative Treatment of Chronic Mallet Fracture Non-union after Failed Pin Fixation

Introduction: Operative treatment of mallet finger fractures is generally recommended for patients in whom more than one-third of the articular surface is involved with volar subluxation. We present a case of conservative treatment with chronic nonunion of a mallet finger fracture after failed mallet finger surgery. Presentation of Case: A 16-year-old boy presented with a bony fragment (mallet formation) of his left long finger. The fragment occupied 40% of the articular surface, with volar subluxation of the distal phalanx. Percutaneous needle curettage of the fracture site and pinning were performed. Six weeks later, the fragment was displaced and had rotated. Hence, all the pins were removed, and a splint was applied. The fracture displayed nonunion and volar subluxation of the distal phalanx. The patient continued with the splinting, and the fracture finally healed. At 27 months after the surgery, radiological examination showed very good remodeling of the distal interphalangeal joint surface with anatomic joint congruence. Functional results at 27 months were good according to Crawford’s classification. Conclusion: Chronic nonunion of a mallet finger can be cured conservatively even when a fracture gap is seen along with displacement of the fragment and volar subluxation of the distal phalanx.

Mallet Finger Fracture Treated with Delta Wiring Technique: A Case Report of a New Fixation Technique.

Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in a case of mallet finger with fracture fragment involving more than one-third of the distal phalanx articular surface. This is the first reported case of mallet fracture treated with delta wiring in literature. A 30-year-old male patient admitted in our institute with complaints of severe pain in the right index finger with inability to extend the distal interphalangeal joint (DIP) for 5 days. There was a history of fall from the bike before this complaint. Radiographs revealed a bony mallet fracture involving more than one-third of the articular surface of distal phalanx. The patient was taken up for delta wiring fixation of the fracture. Radiographic bony union was seen at 7 weeks. At the final follow-up at 1 year, DIP had 75° of flexion and had extension deficit of 5°. According to Crawford's criteria, the patient had good results with a VAS score of 1 with no pain. Delta wiring technique is a new and safe treatment modality for bony mallet fracture with fracture fragment involving more than one-third of the distal phalanx articular surface as satisfactory clinical and radiological outcomes obtained in our case.

Supplemental Method for Reduction of Irreducible Mallet Finger Fractures by the 2–Extension Block Technique: The Dorsal Counterforce Technique

We suggest a method to achieve anatomical reduction in mallet finger fractures that are insufficiently treated by the 2-extension block wire technique. We performed a retrospective review of 18 patients who were found to have an irreducible dorsal fragment and distal interphalangeal joint incongruence owing to rotation of the dorsal fragment in the sagittal plane. In these cases, we additionally employed a dorsal counterforce technique to supplement the 2-extension block technique. An additional K-wire was used to apply counterforce against the distal part of the dorsal fragment and control rotation in the sagittal plane. All 18 fractures united. Congruent joint surfaces and anatomical reduction wereseen in all cases. The mean active flexion of the distal interphalangeal jointswas83.8° (range, 79°-88°) and the mean extension loss was 0.4° (range, 0°-4°). We believe that the dorsal counterforce technique effectively supplements the 2-extension block K-wire technique and aids control of dorsal fragment rotation in the sagittal plane. Therapeutic IV.

Surgical management of mallet finger with extension block pinning

<p class="abstract"><strong>Background:</strong> Various surgical and nonsurgical treatments have been described in the management of mallet finger. The purpose of this study is to evaluate the effectiveness of extension block pinning in the management of displaced mallet finger fractures.</p><p class="abstract"><strong>Methods:</strong> We conducted a retrospective study in which extension block pinning was done for displaced Mallet finger fractures. We included 10 patients in our study who were treated between 2016 and 2018. Fractures were classified according to Wehbe and Schnieder’s classification. All the procedures were done using ring block anaesthesia. Postoperative radiographic assessment was done at each follow up at 15 days interval. Wires were removed after radiologic confirmation of fracture healing. Assessment of the outcome was done using Crawford’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> According to Wehbe and Schnieder’s classification IIB type was the most common. All fractures involved more than 30% of articular surface. Average operative time was 30 mins. Congruent anatomical reduction was achieved in all the patients (intrarticular step off less than 1 mm). Average healing time of the fractures was 40 days. Seven out of the ten patients had excellent results. No wire related complications were seen in our patients.</p><p class="abstract"><strong>Conclusions:</strong> Extensor block pinning when performed accurately is an easy, economical and effective technique in treatment of mallet fingers.</p>

Corrélation entre l’angle d’insertion de la broche bloquant l’extension et la perte d’extension dans les fractures digitales en maillet (mallet finger)

IntroductionExtension-block pinning represents a simple and reliable surgical technique. Although this procedure is commonly performed successfully, some patients develop postoperative extension loss. To date, the relationship between extension-block Kirschner wire (K-wire) insertion angle and postoperative extension loss in mallet finger fracture remains unclear. HypothesisWe aimed to clarify this relationship and further evaluate how various operative and non-operative factors affect postoperative extension loss after extension-block pinning for mallet finger fracture. Materials and methodA retrospective study was conducted to investigate a relationship between extension block K-wire insertion angle and postoperative extension loss. The inclusion criteria were: (1) a dorsal intra-articular fracture fragment involving 30% of the base of the distal phalanx with or without volar subluxation of the distal phalanx; and (2) <3 weeks delay from the injury without treatment. Extension-block K-wire insertion angle and fixation angle of the distal interphalangeal (DIP) joint were assessed using lateral radiograph at immediate postoperative time. Postoperative extension loss was assessed by using lateral radiograph at latest follow-up. Extension-block K-wire insertion angle was defined as the acute angle between extension block K-wire and longitudinal axis of middle phalangeal head. DIP joint fixation angle was defined as the acute angle between the distal phalanx and middle phalanx longitudinal axes. ResultsSeventy-five patients were included. The correlation analysis revealed that extension-block K-wire insertion angle had a negative correlation with postoperative extension loss, whereas fracture size and time to operation had a positive correlation (correlation coefficient for extension block K-wire angle: −0.66, facture size: +0.67, time to operation: +0.60). When stratifying patients in terms of negative and positive fixation angle of the DIP joint, the independent t-test showed that mean postoperative extension loss is −3.67° and +4.54° (DIP joint fixation angles of <0° and ≥0°, respectively, P=0.024). When stratifying patients in terms of extension-block K-wire insertion angle (30°, 30–40°, >40°), ANOVA showed significantly less postoperative extension loss for higher insertion angles (>40°) than for medium insertion angles (30–40°). Mean postoperative extension loss difference between higher insertion angle (>40°) and medium insertion angle (30–40°) was 11° (P=0.002). DiscussionUsing an insertion angle of the extension-block K-wire of 40–45° and a slightly hyperextended position of the DIP joint may help reducing postoperative extension loss. Level of evidenceTherapeutic level III.

Correlation between extension-block K-wire insertion angle and postoperative extension loss in mallet finger fracture

IntroductionExtension-block pinning represents a simple and reliable surgical technique. Although this procedure is commonly performed successfully, some patients develop postoperative extension loss. To date, the relationship between extension-block Kirschner wire (K-wire) insertion angle and postoperative extension loss in mallet finger fracture remains unclear. HypothesisWe aimed to clarify this relationship and further evaluate how various operative and non-operative factors affect postoperative extension loss after extension-block pinning for mallet finger fracture. Materials and methodA retrospective study was conducted to investigate a relationship between extension block K-wire insertion angle and postoperative extension loss. The inclusion criteria were: (1) a dorsal intra-articular fracture fragment involving 30% of the base of the distal phalanx with or without volar subluxation of the distal phalanx; and (2) <3 weeks delay from the injury without treatment. Extension-block K-wire insertion angle and fixation angle of the distal interphalangeal (DIP) joint were assessed using lateral radiograph at immediate postoperative time. Postoperative extension loss was assessed by using lateral radiograph at latest follow-up. Extension-block K-wire insertion angle was defined as the acute angle between extension block K-wire and longitudinal axis of middle phalangeal head. DIP joint fixation angle was defined as the acute angle between the distal phalanx and middle phalanx longitudinal axes. ResultsSeventy-five patients were included. The correlation analysis revealed that extension-block K-wire insertion angle had a negative correlation with postoperative extension loss, whereas fracture size and time to operation had a positive correlation (correlation coefficient for extension block K-wire angle: −0.66, facture size: +0.67, time to operation: +0.60). When stratifying patients in terms of negative and positive fixation angle of the DIP joint, the independent t-test showed that mean postoperative extension loss is −3.67° and +4.54° (DIP joint fixation angles of <0° and ≥0°, respectively, P=0.024). When stratifying patients in terms of extension-block K-wire insertion angle (30°, 30°–40°, >40°), ANOVA showed significantly less postoperative extension loss for higher insertion angles (>40°) than for medium insertion angles (30°–40°). Mean postoperative extension loss difference between higher insertion angle (>40°) and medium insertion angle (30°–40°) was 11° (P=0.002). DiscussionUsing an insertion angle of the extension-block K-wire of 40°–45° and a slightly hyperextended position of the DIP joint may help reducing postoperative extension loss. Level of evidenceTherapeutic level III.

The Ishiguro Technique for the Treatment of Mallet Finger Fracture in Adolescent

The Ishiguro Technique for the Treatment of Mallet Finger Fracture in Adolescent

The Extension Block Technique for the Treatment of Mallet Finger Fracture

The Extension Block Technique for the Treatment of Mallet Finger Fracture

The "Fish Hook" Technique for Bony Mallet Finger.

This study describes a new technique called the "fish hook" technique for the treatment of bony mallet finger. This technique catches the dorsal fragment with a bent K-wire shaped like a fish hook. Transarticular fixation is performed with another K-wire. This technique does not directly penetrate the bone fragment to prevent fragment comminution. This study included 26 patients with mallet finger fractures who underwent surgery using the fish hook technique between 2010 and 2014. The fractures were classified according to the method of Wehbe and Schneider. The fracture fragment was fixed with a fish hook technique in all patients. The K-wire was removed after 6 weeks, when bone union was achieved. Clinical parameters, including range of motion and extensor lag, were assessed at the distal interphalangeal joint according to Crawford's criteria. The mean follow-up period was 12.8 months. Mean extensor lag was 3°, and mean range of flexion of the distal interphalangeal joint was 76°. All patients achieved bone union after 6 weeks. According to Crawford's criteria, there were 20 excellent results, 5 good results, and 1 fair result. No complications, including skin necrosis, pin loosening, and nail deformity, occurred. The fish hook technique is an effective treatment option for bony mallet finger and provides good clinical and radiologic results. [Orthopedics.2016; 39(5):295-298.].

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients

ObjectivesTo evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. MethodsTwenty-five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow-up was 18 months. ResultsThe results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty-one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). ConclusionSurgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Clinical Research is Challenging: Commentary on “Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures”

Clinical Research is Challenging: Commentary on “Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures”

Osteossíntese do dedo em martelo com placa e parafuso: avaliação de 25 pacientes

ObjectivesTo evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. MethodsTwenty‐five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow‐up was 18 months. ResultsThe results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty‐one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). ConclusionSurgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures

To identify factors related to postoperative extension loss when treating mallet finger fractures with extension block pinning. We reviewed 31 consecutive patients with a mallet finger fracture treated with extension block pinning. We measured range of motion of the distal interphalangeal (DIP) joint including extension lag. We investigated the injury mechanism and checked radiographic factors such as DIP joint subluxation, fixation angle, fragment size index, fracture angle, and amount of articular involvement. We performed statistical analyses such as correlation analysis, multiple regression analysis, and independent t test to investigate factors related to postoperative extension loss. Mean voluntary extension loss at final follow-up was 5° (range, 0° to 20°) and mean active flexion of the DIP joint was 84° (range, 75° to 90°). Sixteen patients had a forceful flexion injury and 15 had a simple blow injury. Fixation angle was not associated with postoperative extension loss. Postoperative extension loss increased significantly in the forceful flexion group compared with that in the simple blow injury group. Fragment size index, fracture angle, and amount of articular involvement decreased significantly in the forceful flexion group compared with that in the simple blow injury group and were negatively linearly correlated with postoperative extension loss. Multiple regression analysis showed that sex and injury mechanism affected postoperative extension loss. Sex, injury mechanism, fragment size index, fracture angle, and amount of articular involvement should be considered to anticipate postoperative extension loss even though mallet finger fractures were successfully reduced and healed using extension block pinning. Therapeutic III.