Extension Block Pinning of Mallet Fractures: Comparison Between Early and Delayed Surgery

Abstract

Objective: The objective of this study was to compare the outcomes of individuals who had acute mallet fracture treatment early versus those who underwent delayed surgical treatment. Methods: This was a retrospective cohort study in which all patients were skeletally mature and underwent closed extension pinning surgery for Doyle Type 4B mallet fractures. Crawford criteria were used to evaluate extension lag, loss of DIP joint flexion, and pain outcomes following surgery. All patients were evaluated clinically and radiographically. Results: There were 16 females and 32 males with total of 48 patients in this study. The mean age at the time of surgery was 31.50 ± 9.75 years (range, 19-60 years). A total of 30 patients with early surgical treatment of mallet fractures and 18 patients with delayed surgical therapy were included in the study. There was no significant difference in the active flexion of the DIPJ, Crawford criteria (p=0.085, p=0.907, respectively), except for complication rates (p=0.045). Conclusions: When compared to the early closed extension-block pinning technique, the delayed closed extension-block pinning technique yielded a satisfactory functional outcome in the treatment of mallet fractures.

Reverse Ishiguro Extension Block Technique as an Alternative for Irreducible Osseous Mallet Finger

“…[1][2][3] Although reported to work up to 1 month after injury, 4 late-presenting cases (over 3 wk in adults or 10 d in pediatric patients) might be hard to reduce. 5 This may be due to tissue interposition and the formation of early callus filling the fracture gap and pushing the distal phalanx ventrally, keeping the main fragment palmarly subluxed (Fig. 1).…”

“…The original Ishiguro extension block technique for the treatment of the osseous mallet finger might easily be the most frequently used surgical technique for this specific condition in both adults and children 1–3 . Although reported to work up to 1 month after injury, 4 late-presenting cases (over 3 wk in adults or 10 d in pediatric patients) might be hard to reduce 5 . This may be due to tissue interposition and the formation of early callus filling the fracture gap and pushing the distal phalanx ventrally, keeping the main fragment palmarly subluxed (Fig.…”