Treatment Of Bony Mallet Finger Research Articles

Retrospective study of Ishiguro's technique for mallet bone finger in children: long-term follow-up and analysis of predictors in outcomes.

There is no consensus on the optimal treatment of bony mallet finger in the paediatric population due to a lack of studies in children. The Ishiguro technique is simple and less invasive, and treatment with K-wire fixation seems to provide better results for extension lag in bony mallet finger according to the literature. A retrospective cross-sectional study with long-term follow-up was performed to evaluate the functional and clinical outcomes of this method in children. Preoperative and intraoperative predictors of outcome were investigated. From June to December 2022, we evaluated 95 children who underwent extension K-wire block from 2002 to 2012. Eighty-four children were included (mean age 14.8 ± 1.68years) for a mean long-term follow-up of 11.6 ± 2.3 (8-16) years. Clinical and radiographic features were assessed. Pain and functional outcomes were assessed using Crawford criteria, range of motion (ROM) at the distal interphalangeal joint (DIPJ), loss of extension, and VAS scale. Univariate and multivariate regressions were used to assess which variables might predict the worst outcomes at long-term follow-up. Bone union and pain relief were always achieved. There were no complaints of potential growth impairment or nail deformity. 82.1% of patients showed excellent and good results. Fifteen patients had fair results. Although there are currently no significant differences between surgery and orthosis in adults, the Ishiguro technique is more effective in children when it comes to outcomes in the treatment of mallet fingers. A high percentage of excellent and good results were achieved, and no epiphyseal damage or nail deformity was reported. A strong and significant correlation was found between the worst outcomes and either delayed treatment time or excessive flexion angle.

New technique for the treatment of fresh bony mallet finger: A retrospective case series study.

The bony mallet finger is a tear fracture of the extensor tendon, resulting in a flexion deformity of the finger, which affects both the function of the finger. The classical Ishiguro's method is associated with damage to the cartilage of the distal interphalangeal (DIP) joint and always lead to the joint stiffness. This paper explores a new technique to overcome the shortcomings of the classical Ishiguro's method and achieve better clinical efficacy. We examined 15 patients with bony mallet fingers, 9 males and 6 females, from February 2020 to June 2022, ranged from 23 to 58 years, including 1 case of index finger, 5 cases of middle finger, 3 cases of ring finger and 6 cases of little finger. The median course of the injury to surgery was 2 days (range, 1∼7 days). All had fresh closed injuries, according to the Wehbe and Schneider classification: 4 cases of type IA, 6 cases of type IB, 3 cases of type IIA and 2 cases of type IIB. All patients were treated surgically by the new technique. Post-operative follow-up was conducted to record the healing of the fracture, the pain of the affected finger and the function of joint movement. The 15 cases were followed up after surgery. The median active range of motion was 65° (range, 55∼75°). The median extension deficit of DIP joint was 0° (range, 0∼11°). The median clinical healing time of the fracture was 6 weeks (range, 6∼10 weeks). None of the patients experienced significant pain. The patients were assessed according to the Crawford criteria at the final follow-up: 11 cases were assessed as excellent, 3 cases were assessed as good and 1 case was assessed as fair. No loss of fracture repositioning, loosening of internal fixation, skin necrosis or infection was observed. The application of the new technique for the treatment of bony mallet fingers has the advantages of good stability, fracture healing and functional recovery of the DIP joint, making it an ideal surgical procedure for the treatment of fresh bony mallet fingers.

Osteoarthritis after Extension Block Technique for the Bony Mallet Finger

Purpose: The purpose of this study is to investigate osteoarthritis after treatment of bony mallet finger using the extension block method.Methods: A single institutional retrospective review identified 163 patients with bony mallet between January 2012 and July 2020 and received surgical treatment using extension block method. The radiographic examination showed that the fracture line disappeared and a bridging callus was formed and bone union was confirmed. Fractures were classified according to the Tubiana classification method. Demographic data, fracture pattern, postoperative X-ray, and late complications were analyzed. Clinical outcomes were analyzed using Crawford’s criteria.Results: Surgical treatment was performed within an average of 8.8 days after injury, and the average follow-up period was 11.6 weeks. Osteoarthritis findings were confirmed by joint space narrowing and osteophytes on radiographic examination of 32 out of 163 patients. Age, sex, occupation, location of trauma, operation time, and type of fracture did not affect the osteoarthritis after extension block. Invasion of Kirschner wire (K-wire) to the fracture surface, family history of osteoarthritis, and operation time turned out to have a statistically significant effect on osteoarthritis (p<0.05).Conclusions: Fracture surface invasion of K-wire and family history of osteoarthritis affect osteoarthritis after treatment of bony mallet.

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.

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.

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。

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。

Treatment of bony mallet fingers with Ishiguro method and modified Ishiguro method

Treatment of bony mallet fingers with Ishiguro method and modified Ishiguro method

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.].

EFFECTIVENESS OF MODIFIED Ishiguro TECHNIQUE WITH STRENGTHENING PRESSURE IN TREATMENT OF BONY MALLET FINGERS

To investigate the effectiveness of modified Ishiguro technique with strengthening pressure in the treatment of bony mallet finger by comparing with the traditional Ishiguro technique. Between May 2013 and May 2015, 31 cases of bony mallet finger were treated with traditional Ishiguro technique in 16 cases (control group) and with modified Ishiguro technique in 15 cases (improved group, the two Kirschner wires were bound, which were used to fix the distal interphalangeal joint and blocking avulsion fracture block in the classical Ishiguro technique, and play a continuous elastic compression). Difference was not significant in gender, age, cause of injury, injury finger, and the time from injury to operation between 2 groups (P > 0.05). The wound healing was delayed in 2 cases of the control group and 1 case of the improved group, and the other patients obtained healing by first intension. The follow-up time was 8-23 months (mean, 11 months) in the improved group and was 9-24 months (mean, 12 months) in the control group. Bending deformation of the Kirschner wire occurred in 2 cases of the control group, obvious separation was found between fracture fragment and the distal phalanx; after manual reduction, brace was used to fix, and distal interphalangeal arthritis occurred during follow-up. The fracture healing time was (6.8±0.8) weeks in the control group, and was (5.7±1.5) weeks in the improved group. There was significant difference in the healing time between 2 groups (t=-2.439, P=0.021). At last follow-up, according to Crawford criteria, the results were excellent in 9 cases, good in 4 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 81.25% in the control group; the results were excellent in 10 cases, good in 3 cases, and fair in 2 case with an excellent and good rate of 86.67% in the improved group. There was no significant difference in excellent and good rate between 2 groups (Z=-0.636, P=0.525). Compared with traditional Ishiguro technique, the modified Ishiguro technique with strengthening pressure in treatment of bony mallet finger can facilitate the fracture healing, reduce Kirschner wire loosening and deformation, and decrease the rates of operation failure and complications.

Treatment of Bony Mallet Finger with Hook Plate.

Aim: To present results of patients who had bony mallet finger (BMF) treated with hook plate in our institution. Patients and method: Fifteen patients with BMF who were treated via open reduction and hook plate were enrolled in the study. The demographic features and fracture types of each patient were classified. Crawford criteria, distal interphalangeal (DIF) range of motion, visual analog scale (VAS), and complications were evaluated for the assessment of results. Results: A total of 15 patients (12 men, 3 women, mean age: 27.6 years) were included in the study. The mean follow-up was 14.9 months (range: 6-26 months). While 9 patients were classified as type 1 according to the Wehbe and Schneider classification, the remaining 6 were considered as type 2B. Eight patients were graded as excellent, 6 patients were classified as good, and the remaining 1 patient was considered as moderate in the final control according to Crawford criteria. Average active flexion in the DIF joint was 64.6o (range: 50-70o) and the mean reduction in DIF joint extension was 3.9o (range: 5-15o). Four patients had developed nail bed deformity as a complication. After extraction of the implants, deformity had resolved in three patients; however in 1 patient the aforementioned deformity persisted. Conclusion: The hook plate method in the treatment of BMF is advantageous since it can provide anatomic reduction, stable fixation, early rehabilitation, and satisfactory functional results; however, high cost, difficulty in surgical technique compared to other methods, and postoperative nail deformity make it disadvantageous.

Comparison of Surgical Outcomes of Percutaneous K-Wire Fixation in Bony Mallet Fingers with Use of Towel Clip versus 18-Gauge Needle

Purpose: The purpose was to describe comparative analysis of the surgical outcome of percutaneous K-wire fixation of bony mallet fingers reduced with towel clip and 18-gauge needle. Methods: We analyzed the bony mallet finger patients with more than twelve months follow-up after percutaneous K-wire fixation. The patients were randomly divided into two groups. Eighteen fingers were treated with closed reduction using towel clip and 18 other fingers were treated with closed reduction using 18-gauge needle. Results: Radiographs showed bony union and no subluxation in all cases after K-wire removal. The average extension lag was 2.8°/1.9°, and range of motion of distal interphalangeal joint was 70.3°/75° respectively. According to Crawford’s criteria, excellent results were obtained in 9/11 fingers, good results in 8/7 fingers, and poor result in 1/0 finger, respectively. Conclusion: 18-gauge needle reduction in percutaneous K-wire fixation is considered less invasive and useful method for treatment of bony mallet finger with comparable results with towel clip reduction.

Treatment of bony mallet finger using a modified pull-out wire suture technique

Treatment of bony mallet finger using a modified pull-out wire suture technique

Is the Use of Biodegradable Devices in the Operative Treatment of Avulsion Fractures of Fingers, the So-Called Mallet Finger Advantageous? A Feasibility Study with Meniscus Arrows®

Purpose:Treatment of Mallet fingers or fractures remains a controversial topic. No evident preference can be distilled from the reports of the clinical results obtained by conservative treatment with splints and internal fixation. If operative treatment is indicated, several techniques can be used. However, each technique has disadvantages like the risk of comminution of the fragment, the risk of infection and necrosis, a demanding operative technique and-or the necessity of removing the metallic devices. This can be avoided by the use of biodegradable devices. The purpose of this feasibility study was to evaluate the outcome of internal fixation of a Mallet fracture with a biodegradable device, the Meniscus Arrow®.Methods:We treated nine consecutive patients with a Mallet fracture by fixation of the fragment with a biodegradable Meniscus Arrow®, at this moment the smallest device available, with an average operation time of 14 minutes.Results:Postoperatively, no complications were found. All patients were satisfied by the results after surgery, with a restored range of motion in the distal interphalangeal joint as previously and good alignment with full consolidation of all fractures at radiological evaluation.Conclusions:The operative treatment of bony mallet fingers with the Meniscus Arrow® is a fast procedure without complications in our prospective series of nine patients and without the need of a second operation to remove the implant.

Treatment of Mallet Finger Fracture by Extension Block K-wire Fixation

Purpose: The purpose of this study was to evaluate the outcomes of the extension block fixation technique for a bony mallet finger. Materials and Methods: Thirty-five patients that received extension block fixation for bony mallet finger were enrolled in this study between July 2001 and October 2005. The fracture type was classified by the Wehbe and Schneider method. The average follow up period was 15 months, ranging between 12-52 months. The results were classified by the Crawford criteria. Results: There was 30 cases of type I, 5 cases of type II and no cases of type III, with 11 cases of subtype A, 22 cases of subtype B, and 2 cases of subtype C. The average time from injury to operation was 12 days, which included three cases of over 28 days. The K-wire was removed 30 days after the operation, and joint exercises were initiated immediately. There were 10 cases with excellent outcomes, 18 cases with good outcomes, 4 cases with fair outcomes, and 3 cases with poor outcomes. The poor outcome had complications such as subluxation of the DIP joint, lag between injury to operation time (more than 4 weeks), and more than 1 mm displacement. Conclusion: The extension block technique for the treatment of bony mallet finger is relatively simple and results in satisfactory bone union.