Mallet Deformity of the Finger

Abstract

We reviewed 31 patients at a mean of five years after mallet deformity of the finger had been treated with a thermoplastic splint. Intra-articular fractures were present in 35% of patients. Osteoarthritic changes had developed in 48%, most in association with fracture, and 29% had a swan-neck deformity. There was a loss of extension greater than 10° in 35%; the average deficit at the interphalangeal joint was 8.3° and the average flexion arc was 48.5°. Despite these findings, patient satisfaction was generally high, with little evidence of functional impairment.

Fixação de fraturas em martelo com técnica de placa de gancho modificada: Uma série de casos prospectivos de 17 pacientes

“…O tratamento ideal das fraturas em martelo ainda é controverso; 6 no entanto, a maioria dos cirurgiões concorda que o manejo inadequado de tais lesões pode levar a problemas do mecanismo extensor, como retardo de extensão ou deformidade em pescoço de cisne, ou ainda artrite da AIFD com subsequente prejuízo funcional. 3,10,12 Embora o tratamento conservador tenha ótimos resultados, é amplamente aceito que uma fratura intra-articular com acometimento de mais de um terço da superfície articular ou subluxação da AIFD é uma indicação para intervenção cirúrgica. 1,2,7 Apesar do desenvolvimento de várias técnicas para o tratamento cirúrgico, incluindo percutâneas e abertas.…”

“…The ideal management of mallet fractures remains a matter of dispute 6 ; however, most surgeons agree that inadequate management of such injuries can lead to extensor mechanism problems such as extension lag or a swan neck deformity, or DIPJ arthritis with subsequent impaired function. 3,10,12 Although nonoperative management showed optimum results, it is widely accepted that an intra-articular fracture involving more than a third of the articular surface or subluxation of the DIPJ is an indication for surgical intervention. 1,2,7 Although various techniques have been developed for surgical treatment, including percutaneous and open techniques, utilizing different fixation methods such as wires, sutures, plates, and screws, none was without complications.…”

“…2 Inadequately treating such injuries could lead to various complications, including extensor lag, swan neck deformity, arthritis, pain, and loss of function. 3,4 Mallet fractures are usually managed non-surgically using an orthosis such as the Stack orthosis or custom-made splints. 5 Although no consensus exists on the indications for surgical management, most surgeons would consider surgical options when the fracture involves more than a third of the articular surface or in the presence of joint subluxation.…”

“…Traumatic mallet finger is a common injury involving the extensor tendon of the distal interphalangeal joint (DIPJ), 1 which could involve a fracture with bony avulsion of a variable-sized fragment together with the attachment of the extensor tendon, also known as the “bony mallet finger” or a “mallet fracture.” 2 Inadequately treating such injuries could lead to various complications, including extensor lag, swan neck deformity, arthritis, pain, and loss of function. 3 4 Mallet fractures are usually managed non-surgically using an orthosis such as the Stack orthosis or custom-made splints. 5 Although no consensus exists on the indications for surgical management, most surgeons would consider surgical options when the fracture involves more than a third of the articular surface or in the presence of joint subluxation.…”

“…2 Seu tratamento inadequado pode gerar várias complicações, inclusive retardo de extensão, deformidade em pescoço de cisne, artrite, dor e perda de função. 3 4 De modo geral, as fraturas em martelo são tratadas de forma conservativa com órteses, como as talas de Stack ou feitas sob medida. 5 Embora não exista consenso sobre as indicações para tratamento cirúrgico, a maioria dos cirurgiões o considera caso a fratura envolva mais de um terço da superfície articular ou haja presença de subluxação articular.…”