A novel closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation for mallet fractures

Abstract

Background Some patients with mallet fractures who undergo extension block pinning complain of exposed wires, which delay their return to sports and causes inconvenience while performing tasks that require the use of hands during the early postoperative period. The purpose of this retrospective study was to present and evaluate a novel surgical procedure for mallet fractures.MethodsWe treated 20 patients (14 males and six females; mean age, 38.4 years; range 17–68 years) with displaced mallet fractures involving >30 % of the articular surface using the closed reduction and microscrew fixation between January 2009 and January 2012. The distal interphalangeal joint (DIP) joint was immobilized with a splint for 1–3 weeks on an individual case basis. According to Wehbe and Schneider’s classification, there were 12 type IB, six type IIB, and two type IA fractures. The mean follow-up duration was 12.6 months (range 6–31 months).ResultsBone union was achieved in all patients within a mean period of 6.8 weeks, with no incidence of infection, skin necrosis, permanent nail deformity, or secondary osteoarthritis. Only two complications—temporary nail ridging in one patient and a dorsal bump caused by the screw in one patient—were observed. Minimum postoperative displacement was observed in one patient, for whom immobilization with a splint was continued for 4 weeks. Articular incongruity was <1.0 mm in four patients and 1.0–2.0 mm in two patients. Mean DIP joint extension loss was 6.5° and mean flexion was 67.8°. The surgical outcomes were excellent in seven patients, good in nine, and fair in four according to Crawford’s evaluation criteria.ConclusionOur novel surgical procedure combining closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation produces good clinical results with relatively few complications.

Review of Acute Traumatic Closed Mallet Finger Injuries in Adults

“…Reduction and fixation of the displaced fragment can performed directly and/or indirectly. Direct methods include the transosseous suture of a tendinous mallet or of a small bony fragment [ 45 ], as well as fixation of a large bony fragment with a variety of hardware, such as K-wires [ 38 46 47 48 49 ], screws [ 50 ], needles [ 51 ], external fixators [ 52 ], tension wires [ 53 ], and plates [ 54 55 ]. Indirect methods involve reducing and fixing the displaced bone without going through the osteotendinous lesion.…”

Clinical comparison of hook plate fixation versus extension block pinning for bony mallet finger: a retrospective comparison study

“…Ishiguro et al (1988) first described the percutaneous extension block method of indirect reduction in bony mallet finger. Since then, different indirect reduction techniques, such as the modified Ishiguro technique, have been reported (Chung and Lee, 2012; Shimura et al, 2014; Tetik and Gudemez, 2002). However, these methods rarely achieve an excellent reduction and do have some poor outcomes and complications (Szalay et al, 2011; Teoh and Lee, 2007).…”

Pull-out suture technique and micro-bone anchor fixation: a comparison of two methods in the treatment of nonosseous mallet finger injuries

“…2,5,6,8,9,14 There are some disadvantages of mallet finger surgeries, such as difficulty in achieving earlier mobilization; the incidence of nail deformity, joint incongruity, skin necrosis, and infection; and limitation of flexion of the DIP joint. 4,5,14,17,18 Kang et al 19 reported that postoperative complications of surgically treated mallet finger deformities developed in 41% of patients. In this study, postoperative complications developed in 17% in Group 1 and 15% in Group 2.…”