Mallet Toe of the Hallux Treated by Bridging Suture Technique Using Suture Anchors: A Case Report and Literature Review

Abstract

An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called "mallet toe" of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, percutaneous or open Kirschner wire fixation similar to that in the mallet finger, or suture anchor fixation. We present a case treated by the bridging technique using two suture anchors. A 57-year-old Japanese man injured his left great toe after a fall while walking barefoot on the bed. His great toe was forced into a hyperplantarflexion position. Plain radiography and computed tomography showed a small bone fragment at the base of the dorsal distal phalanx, suggesting an avulsion fracture of the extensor hallucis longus. He was treated by bridging suture technique with two suture anchors. At first, two suture anchors were inserted to the fracture bed of the distal phalanx, and then the bone fragment and extensor hallucis longus tendon were secured with two horizontal mattress sutures. Finally, bridging sutures were performed using the remaining sutures and the sutures used for mattress suturing. He obtained bony union and symmetric range of motion of the interphalangeal joint. This technique allowed us to fix the small bone fragment rigidly and mobilize the interphalangeal joint earlier to preserve the range of motion. It would be a valuable procedure when the bone fragment is small.