Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger.@*METHODS@#Between January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training.@*RESULTS@#The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%.@*CONCLUSION@#Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.

Fijación percutánea para manejo de dedo en martillo. Estudio de Corte Transversal / Percutaneous internal fixation for mallet finger injuries. Cross-sectional study

Introducción El movimiento de los dedos es dado por un complejo mecanismo que combina tanto extensión como flexión. La alteración del mecanismo extensor en la zona descrita como I, produce una deformidad del dedo conocida como dedo en martillo. El cual puede tener manejo conservador o inclusive quirúrgico cuando está indicado. Materiales y Métodos Estudio observacional descriptivo de tipo corte transversal retrospectivo de pacientes intervenidos por lesión de dedo en martillo en la mano entre junio de 2017 y enero de 2018, operados por cirujanos del módulo de mano a partir de la técnica quirúrgica percutánea con pin transóseo. Resultados Con un total de 48 de pacientes, el 81,25% de los casos fueron hombres, entre los 31 y los 55 años, en su gran mayoría diestros, con mayor frecuencia de lesión de la mano derecha y en el 41,67% de los casos con compromiso del segundo dedo, seguido del tercer dedo (39,58%), secundario a un trauma contuso. Adicionalmente se reportó complicaciones en 2 pacientes (4,16%). Discusión El dedo en martillo es una lesión en su mayoría secundaria a un trauma contuso, de predominio en hombres y de la mano dominante, la cual puede recibir manejo conservador a partir del uso de una férula tipo stack o quirúrgico. Los resultados reportados en el presente estudio siguen los datos descritos por la literatura internacional, encontrándose de forma adicional, la presentación de múltiples comorbilidades y siendo rara la incidencia de la lesión en poblaciones jóvenes. La población atendida presenta características demográficas y relacionadas a la lesión similares a las reportadas en la literatura internacional.

Background The movement of the fingers is given by a complex mechanism that combines both extension and flexion. The alteration of the extensor mechanism at distal interphalangeal joint of the finger is known as mallet finger. Mallet finger can be managed either surgically or not surgically with external splints. Materials and methods A retrospective cross-sectional descriptive observational study was performed including patients diagnosed with mallet finger injury between June 2017 and January 2018 surgically treated with percutaneous internal fixation surgical technique using a transosseous pin. Results A total of 48 patients were included, 81.25% of the cases were men, between 31 and 55 years old, the vast majority right-handed, with a higher frequency of injury to the right hand. 41.67% of cases involved the second finger, followed by the third finger (39.58%), secondary to a blunt trauma. Additionally, complications were reported in 2 patients (4.16%). Discussion Mallet finger is an injury mostly secondary to a blunt trauma, predominantly in men and of the dominant hand, which can receive conservative management from the use of a stack-type or surgical splint. The results reported in the present study follow the data described in the international literature, additionally finding the presentation of multiple comorbidities and the incidence of injury in young populations being rare. The population treated presents demographic and injury-related characteristics similar to those reported in the international literature.

Anatomical study on finger of extensor tendon in zone Ⅰ / 局解手术学杂志

Objective To discuss the effect of proximal interphalangeal joint(PIPJ) motion on the tension of the zone Ⅰ extensor tendon through measuring the extensor tendon and find the fixed position of PIPJ when the zone Ⅰ extensor tendon at minimum tension,and to provide reference for best fixed position in clinical treatment.Methods The maximal passive flexion angles of the distal interphalangeal joint (DIP J) of the index,distal,ring and little fingers were measured in 20 cadaver hands when the PIPJ flexed at 0 °,20 °,40 °,60 °,80 ° and 100 °.Making an incision over the back of the DIPJ to expose the zone Ⅰ extensor tendon.Incising the extensor tendon laterally at the level of the DIPJ with the DIPJ fixed in extension position to make a mallet finger.Pierced a Kirschner wire through and perpendicular to the distal phalangeal basement as a sign.Parallel to this sign,marked the zone Ⅰ extensor tendon and measured its relative distance to the sign as the sliding distance of the extensor.Recording the widest gap between the tendon edges and the tendon sliding distance while the PIPJ was in extension and 20°,40°,60°,80° and 100°flexion position,severally.Results The maximal passive flexion angle of the DIPJ increased with the PIPJ flexed from 0°to 100°in 80 fingers.The gap between the extensor tendon edges in zone Ⅰ was (1.322 8 ± 1.078 9) mm when the PIPJ was in extension position.The proximal extensor tendon glide distally while the PIPJ flexed to 100° with an average sliding distance of(1.540 5 ± 0.690 7) mm.Conclusion The zone Ⅰ extensor tendon has the maximal tension while the PIPJ is in extension position.Flexing PIPJ can make the tension decrease.

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture / 中华医学杂志(英文版)

<p><b>Background</b>Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities.</p><p><b>Methods</b>Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed.</p><p><b>Results</b>The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons.</p><p><b>Conclusions</b>Sports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.</p>

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients / Osteossíntese do dedo em martelo com placa e parafuso: avaliação de 25 pacientes

To evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. METHODS: Twenty-five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow-up was 18 months. RESULTS: The results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty-one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). CONCLUSION: Surgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Avaliar os resultados do tratamento cirúrgico de pacientes com lesão de dedo em martelo com o uso de placa-gancho e parafuso. MÉTODOS: Foram analisados 25 pacientes entre 20 e 35 anos, 19 do sexo masculino e seis do feminino, de maio de 2008 a dezembro de 2012. Os pacientes foram submetidos à avaliação de acordo com os critérios de Crawford e o acompanhamento médio foi de 18 meses. RESULTADOS: Os resultados obtidos foram excelentes em 10 pacientes (40%) e bons em 15 (60%); 21 pacientes (84%) não referiram dor no 18° mês de pós-operatório. Foi verificada ausência de limitação da amplitude de movimento em 14 casos (56%), limitação da extensão em sete (28%) e limitação da flexão em quatro (16%). CONCLUSÃO: O tratamento cirúrgico com redução aberta e fixação interna com placa-gancho e parafuso demonstrou ser uma ótima opção de tratamento nas fraturas em martelo e é considerado um método seguro e eficaz.

EFFECTIVENESS OF PART LONG THUMB EXTENSOR TENDON DORSAL ULNAR ARTERY CHIMERIC FLAP FOR REPAIR OF Doyle TYPE Ⅲ MALLET FINGER OF THUMB / 中国修复重建外科杂志

OBJECTIVE: To investigate the effectiveness of part long thumb extensor tendon dorsal ulnar artery chimeric flap for repair of Doyle type Ⅲ mallet finger of thumb.

Evaluation of Fragment Reduction Feasibility When Treating Bony Mallet Finger Using Extension Block K-Wire Technique

PURPOSE: The purpose was to evaluate fragment reduction feasilibty when applying extension block Kirschner-wire technique for bony mallet finger. METHODS: We treated 48 displaced mallet finger fractures by a two extension block Kirschner-wire technique. Among these operation group, we found dorsal rotation of fragment in 18 cases, making it difficult to get anatomical reduction. The patients were divided into two groups. One group of 30 patients did not show dorsal rotation of fragment and anatomical reduction was achieved easily. Another group of 18 patients showed dorsal rotation of fragment and additional methods was applied to achieve anatomical reduction. RESULTS: Joint surface involvement was significant greater in groups showing dorsal rotation of fragment than group which did not show (57.1% and 49.7%, respectively) (p=0.01). The groups whose joint surface involvement more than 50% had higher risk of dorsal rotation of fragment than the group less than 50%, with the odds ratio of 6.11. CONCLUSION: We could encounter the cases which showed dorsal rotation of the fracture fragment when treating the bony mallet finger with extension block K-wire technique especially the joint surface involvement was more than 50%. So if we can evaluate the extents of joint surface involvement and prepare additional method preoperatively when dorsal rotation of fragment is expected, it is possible to get more favorable results.

Review of Acute Traumatic Closed Mallet Finger Injuries in Adults

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

Clinical curative effect analysis on micro anchor combined with Kirschner wire for treatment of mallet finger / 中国医师进修杂志

Objective To explore the clinical curative effect of micro anchor combined Kirschner wire for treatment of mallet finger.Methods Fifteen patients with mallet finger were treated with operation therapy of micro anchor combined with Kirschner wire fixation,postoperative the distal interphalangeal joint dorsiflexion,proximal interphalangeal joint flexion splint fixation for 4 weeks,pulling Kirschner wire 6 weeks later,and active and passive functional exercise of distal interphalangeal joint.Results Fifteen patients incisions healed well,with no complications.Fifteen patients were followed up for 6-12 months.At last follow-up,9 cases were excellent,5 cases were good,and 1 case was poor.Conclusion The micro anchor combined with Kirschner wire for treatment of mallet finger is simple and effective.

Value of high frequency ultrasonography in acute closed mallet finger / 中华超声影像学杂志

Objective To study the clinical value of high frequency ultrasonography in acute closed mallet finger.Methods The high frequency ultrasonographic images of thirty-six patients with diagnosed acute closed mallet finger were retrospective analyzed.The ultrasonographic features were analyzed.Results The position and internal structure of extensor tendon could be showed by high frequency ultrasound,the position and injury level of acute closed mallet finger were identified.In 36 patients of acute closed mallet finger,6 cases were complete tear combined avulsion fracture,the ultrasonography showed the disruption in the extensor tendon at the level of the distal interphalangeal joint,the hyperechoic fracture fragment were found in the distal end of extensor tendon.22 cases were complete tear and no avulsion fracture,the longitudinal imaging showed the disruption in the extensor tendon at the level of the distal interphalangeal joint and the retraction of the tendon end.8 cases were partial tear,the ultrasonography showed that extensor tendons were thickened and hypoechoic,the section of extensor tendons were still continuous.Conclusions High frequency ultrasonography is the preferred imaging method for diagnosis of acute closed mallet finger,it will be important value for clinical treatment method.

"Delta(Delta) wire Technique" for Bony Mallet Finger: Surgical Technique / 대한정형외과연구학회지

Bony mallet finger is treated by from conservative management to various operative options. A lot of internal fixations except hook plate lead to cartilage damage and limitation of motion of distal interphalangeal joint. Thus we introduce Delta(Delta)-wire technique which can permit early joint motion and give strong compression force on the fracture fragment continuously.

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 2.8degrees/1.9degrees, and range of motion of distal interphalangeal joint was 70.3degrees/75degrees 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.

Prognostic Factors of the Extension Block Technique for the Bony Mallet Finger / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical results and prognostic factors of the extension block technique for treating a bony mallet finger. MATERIALS AND METHODS: Between July 2002 and January 2009, forty-nine patients who underwent the extension block technique for a bony mallet finger were evaluated. The minimum period of follow up was 6 months. The type of fracture was classified by the Wehbe and Schneider method. The results were evaluated by the Crawford classification. The prognostic factors were analyzed according to age, gender, the timing of the surgery, the mallet fragment angle and the residual displacement. RESULTS: According the Crawford classification, there were 22 excellent, 20 good, 6 fair and 1 poor results. The poor prognostic factors were an older patient age, subluxation, a smaller mallet fragment angle and smaller postoperative displacement (p<0.05). CONCLUSION: The prognostic factors of the extension block technique for bony mallet finger were the patient age, subluxation, the mallet fragment angle (more than 30 degrees) and the postoperative displacement.

Open Reduction and K-Wire Fixation for Mallet Finger Fractures

PURPOSE: To evaluate the results of open reduction and K-wire fixation in patients with a displaced dorsal intraarticular fracture of the distal phalanx. MATERIALS AND METHODS: From May 1999 through April 2008, 32 fingers (32 patients) with a mallet finger fracture involving one-third or more of the articular surface and/or a subluxated distal phalanx were included. While maintaining the reduction of the dorsal fracture fragment obtained by open method, two K-wires were introduced to fix the fragments and the third K-wire to fix the distal interphalangeal joint. Clinical results were investigated at an average follow-up of 13 months. RESULTS: Radiologically, solid bony union was observed in all fingers at an average of 6.5 weeks after the operation. The final results showed exellent in 17 patients(53.1%), good in 14 patients(43.8%) and fair in one(3.1%) according to the criteria suggested by Crawford. CONCLUSION: Open reduction and K-wire fixation of the displaced bony mallet fractures is considered as an acceptable surgical method in providing successful bony union and maintenance of joint motion.

Modified Extension Block Technique Using Conjoined Kirschner Wires for Bony Mallet Fingers

PURPOSE: To analyze the clinical results of the modified extension block fixation method using conjoined K-wires for bony mallet fractures. MATERIALS AND METHODS: From March 2006 to March 2009, we performed conjoined K-wire fixation as a modification of extension block technique in 9 patients with a bony mallet finger. After the average follow-up of 4.8 months, range of motion, pain, nail deformity, and bony union were evaluated. RESULTS: The average range of motion was 3.3degrees (range, 0-20degrees)of extension lag and 76.7degrees (range, 45-90degrees) of flexion. Bony union was obtained in all patients. No nail deformity was observed. One patient complained of distal interphalangeal joint pain. CONCLUSION: The extension block fixation method using conjoined K-wires can be an acceptable treatment option which provides stable fixation in bony mallet fractures.

Closed Reduction and Percutaneous K-Wire Fixation of Bony Mallet Finger Using an 18 Gauge Needle

PURPOSE: To evaluate the clinical results of the treatment of the percutaneous Kirschner wire fixation of bony mallet finger using an 18 gauge needle. MATERIALS AND METHODS: From September 2002 to September 2009, we performed closed reduction using an 18 gauge needle and percutaneous fixation with Kirschner wire for 15 cases of bony mallet finger and followed up at least 1 year. The fractures were classified by the Wehbe and Schneider's method. Indications of operative treatment were fractures involving more than 30% of articular surface, fracture fragments displaced more than 3 mm, or subluxation of the distal interphalangeal joint. The results were evaluated by the Crawford criteria. RESULTS: All the fractures united, with an average healing time of 5.3 weeks(4-6 weeks). According to Crawford criteria, 10 cases were excellent, 5 cases were fair at a mean follow-up of 13 months. There were no pin tract infections and migrations of the pin. CONCLUSION: Percutaneous Kirschner wire fixation of mallet finger using an 18 gauge needle is an easy technique which can achieve anatomical reduction and diminish operation-related complications.

Surgical Treatment of Mallet Finger Deformity with Hook Plate

PURPOSE: The bony mallet finger injury is generally managed by conservative treatments. But operative treatments are needed especially when the fractures involve above 30% of articular surface, or when distal phalanx is accompanied by subluxation in the volar side. This is the reason why they often result in chronic instability, articular subluxation and cosmetic dissatisfaction. In this report, We describe new method using the hook plate as an operative treatment of mallet finger deformity. METHODS: Among 13 patients with mallet finger deformity who came from February 2006 to February 2008, six patients were included in surgical indication. Under local anesthesia, H or Y type incision was made at the DIP joint area. After the DIP joint extension, the hook plate was put on the fracture line, and one self tapping screw was used for fixation. 2 hole plate which was one of the holes in 1.5 mm diameter was cut in almost half and bended by approximately 100 degrees. RESULTS: In all six cases which were applied the hook plate, complications such as loss of reduction or nail deformity were not seen. In only one patient, hook pate was removed due to inflammatory reaction after the surgery. In 2 weeks after the operation, active motion of DIP joint was performed. The result was satisfactory not only cosmetically but also functionally. In 6 weeks after the operation, the range of motion of DIP joint was average 64 degrees. CONCLUSION: The purpose of the operative treatment for mallet finger deformity using the hook plate is to provide anatomical reduction with rigid fixation and to prevent contracture at the DIP joint. While other operations takes 6 weeks, the operation using the hook plate took only two weeks to enable active motion. Complication rate was low and the method is rather simple. Thus, the operation using the hook plate is recommended as a good alternative method for the mallet finger deformity treatment.

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

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.

Pull-in Suture Technique for the Disinsertion of the Phalangeal Tendon Distal Insertion

PURPOSE: The disinsertion of the phalangeal tendon distal insertion has difficulties in ordinary tenorrhaphy operation for the anatomical features, and still has controversy between non-surgical and surgical management. The purpose of this study is to select treatment for the injury of the phalangeal tendon distal insertion, as we've had a good results from operation treatment with Pull-in suture technique. METHODS: We reviewed the hospital records of 12 patients treated with Pull-in suture technique with disinsertion of the phalangeal extensor or flexor tendon distal insertion from June 2006 to June 2007. Eight patients were involved with the tendon disinsertion without bone fracture, and 4 patients were involved with the fracture of the phalangeal tendon distal insertion site. After removal of the K-wire in week 6, active physical exercises were commenced immediately. The mean follow-up period was 12.4 months. RESULTS: All the patients who had tendon disinsertion with bone fracture had IIB, by Wehbe and Schneider's classification 2, and we evaluated the results comparing the same finger of the other hand according to Crawford's evaluation criteria 5. The nine excellent and three good results were obtained and there were no limitation of motor for the patient who had operation for the rupture of flexor tendon as well. There were no particular complications during the follow-up period. CONCLUSION: The most important thing for the disinsertion of the phalangeal tendon distal insertion is to maintain an accurate and durable reduction state keeping the tension of tendon. At this point, after removal of the K-wire, the Pull-in suture technique allows accurate realignment of the tendon-bone unit without any specific instrumentation under the more stable state. The Pull-in suture technique seems to be a strong alternative for the treatment of disinsertion of the phalangeal tendon distal insertion, with successful treatment outcome(rapid functional recovery and high patient satisfaction).

Therapeutic effect of micro-anchor in chronic mallet finger deformity / 中国矫形外科杂志

Objective To introduce the method of treating chronic mallet finger using Micro Arc bone Anchor, and investigate the feasibility of this method with the clinical effects.MethodFourteen chronic mallet fingers were treated with Micro Arc bone Anchors. During the operation, a "?" skin incision over the dorsum of the DIP joint was made to expose the extensor tendon and resect the scar tissue between the disrupted ends. Then the DIP joint was made at extending position was immobilized with a 1mm Kirschner wire and the ends of extensor tendon was sutured with horizontal mattress suture method. After that,the Micro Arc bone Anchor was sutured into the dorsal base of the distal phalanx,the suture thread attached the end of anchor was tied to the proximal end of the extensor tendon to reinforce the former suture. External fixation on the anterior face of forearm was applied to immobilize the wrist at 30?of extention and the metacarpophalangeal and interphalangeal joints and extending position for 3 w, and Kirschner wire fixation was taken out 6 w postoperatively. Functional exercises were performed after the Kirschner wires were removed.ResultAll the cases were followed up for 6 months to 1 year, and excellent results were obtained in 10 cases, good in 2, fair in 2 and poor in 1 according to Dargan's functional assessment system, with dysfunction of flexion in DIP joint in 1 case, and recurrence of abnormity in 1 case.The total rate of excellent and good results was 85.7%.ConclusionMicro Arc bone Anchor is a convenient and effective alternative for the treatment of chronic mallet finger deformity with many advantages such as the high suturing intensity,low recurrence rate of abnormity, convenient for operation and reliable effect.