Modified Transosseous Wiring Technique for Neglected Fracture–Dislocation of the Proximal Interphalangeal Joint

BACKGROUND: Fracture–dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture–dislocations of the PIP joint. METHODS: Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture–dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months). RESULTS: All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8). CONCLUSIONS: For chronic fracture–dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.

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.

Anatomic Reduction of Mallet Fractures Using Extension Block and Additional Intrafocal Pinning Techniques

BACKGROUND: The purpose of this article is to report the efficacy of the extension block pinning and additional intrafocal pinning technique applied to cases whose mallet fractures were not reduced with extension block pinning alone. METHODS: We retrospectively reviewed 14 digits with 14 patients who were treated with the extension block pinning and additional intrafocal pinning technique. There were eight men and six women with an average age of 34 years. The average articular surface involvement was 52%. The average follow-up was 16 months and the mean time from injury to operation was 23 days. RESULTS: All the cases achieved anatomic reduction of fractures. By Crawford's classification, 9 were excellent and 5 were good. The average active flexion of the distal interphalangeal joint was 78 degrees and the average extension loss was 1.8 degrees. Bone union was observed in all cases after a postoperative mean of 38.4 days. Complications such as skin necrosis, fracture of bony fragments, and nail-plate deformity were not found. CONCLUSIONS: Additional intrafocal pinning technique is considered a simple and useful method to obtain anatomic reduction of mallet fractures in cases where extension block pinning alone is insufficient to restore the anatomic configuration of the articular surface.

Anatomic Reduction of Mallet Fractures Using Extension Block and Additional Intrafocal Pinning Techniques

BACKGROUND: The purpose of this article is to report the efficacy of the extension block pinning and additional intrafocal pinning technique applied to cases whose mallet fractures were not reduced with extension block pinning alone. METHODS: We retrospectively reviewed 14 digits with 14 patients who were treated with the extension block pinning and additional intrafocal pinning technique. There were eight men and six women with an average age of 34 years. The average articular surface involvement was 52%. The average follow-up was 16 months and the mean time from injury to operation was 23 days. RESULTS: All the cases achieved anatomic reduction of fractures. By Crawford's classification, 9 were excellent and 5 were good. The average active flexion of the distal interphalangeal joint was 78 degrees and the average extension loss was 1.8 degrees. Bone union was observed in all cases after a postoperative mean of 38.4 days. Complications such as skin necrosis, fracture of bony fragments, and nail-plate deformity were not found. CONCLUSIONS: Additional intrafocal pinning technique is considered a simple and useful method to obtain anatomic reduction of mallet fractures in cases where extension block pinning alone is insufficient to restore the anatomic configuration of the articular surface.

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.

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.

Modified Extension Block Technique for Large Mallet Fracture

PURPOSE: To evaluate retrospectively the clinical results of modified extension block technique for large mallet fracture. MATERIALS AND METHODS: From May 2006 to August 2007, we reviewed 16 patients who got surgery with large mallet fracture. Surgical indications included fractures involving more than 33% of the articular surface or fractures associated with subluxation of the distal interphalangeal joint. The average age was 32.6 years old. The average time from injury to surgery was 10days. We performed modified extension block technique in all patients. The pins were removed between 5 to 6 weeks when we confirmed bone union by radiology. Function outcomes were determined by using the Crawford criteria. RESULTS: The average fracture fragment size was 52% of the joint surface. Average time to fracture union was 5.4weeks(4.5~7.5weeks). At a mean follow-up of 8.2months(5-13months) average extension loss was 3degrees (0-10degrees )and average flexion was 77degrees (60-85degrees ). According to Crawford classification, 81.3% of paitents had excellent or good results. There were 2 nail deformity. CONCLUSION: Modified extension block technique can make up for the weak points of traditional techique in the treatment for large mallet fracture.

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.

The Result of the Modified Extension Block Technique in Bony Mallet Finger

PURPOSE: To evaluate the treatment outcomes of the modified extension block technique for bony mallet finger. MATERIALS AND METHODS: This study included 16 patients who had been treated with the modified extension block technique for bony mallet finger from December 2002 to January 2004. The average duration of follow up was 13 (12~17) months. The indication of operation was the presence of a large bony fragment invading more than 1/3 of the articular surface or the palmar subluxation in the distal interphalangeal joint. RESULTS: The average extension lag was 2.3 degrees, and the range of motion of the distal interphalangeal joint was 68.8 degrees. Radiograph showed bony union state in all cases. By the Crawford's evaluation criteria, 12 cases (75%) was excellent or good. Postoperative complications occurred in 3 cases, which were reduction loss within postoperative 2 weeks in 2 cases and mild pain with motion in 1 case. CONCLUSION: The modified extension block technique is a easy and simple method. It shows a good result without complications from skin incision. So, it seems a useful method for bony mallet finger.

Extension Block by the Posterior Cruciate Ligament Partial Rupture in the Knee: A Case Report

Although it is well known that extension block in the injured knee is usually attributed to a meniscus tear or anterior cruciate ligament rupture, it is vary rare to cause mechanical extension block by the torn posterior cruciate ligament. We report a case of posterior cruciate ligament partial rupture who presented persistent extension block caused by a nodule formation in a 12-year-old boy after knee trauma and was treated with arthroscopic resection of the nodule.

Treatment of Bony Mallet Finger: Closed Reduction Using Extension Block K-wire

PURPOSE: To review the result of bony mallet finger treated with a closed reduction using extension block K-wire MATERIALS AND METHODS: Between January 2001 and November 2002, among the patients with bony mallet finger underwent closed reduction using extension block K-wire, we retrospectively reviewed 14 patients with 14 fractures who had a minimum follow-up of 12 months. RESULTS: There were 10 men and 4 women, with an average follow-up for all cases 15.7 months (range, 12 months~18 months). According to Crawford's evaluation criteria, we obtained 7 excellent, 5 good, 2 fair. We obtained bony union in all patients, with no remained pain. The average ROM was 67 degrees at postoperative 12 months. Postoperative complications occurred in two cases, which were nail deformity and mild osteoarthritis at the distal interphalangeal joint. There was no pin site infection. CONCLUSION: This technique is not only easier but also less invasive than other techniques for reduction of mallet finger. Also, it shows excellent result with lower complication rate. So, it seems a reliable treatment for bony mallet finger.

Discoid Lateral Meniscus in Children: Analysis of the Clinical Manifestations in relation to the Shape of the Discoid Lateral Meniscus / 대한정형외과학회잡지

PURPOSE: The clinical manifestations of discoid meniscus in children are usually different from those in adults. We attempted to find the relationship between the clinical symptoms and shape of discoid meniscus in children. MATERIALS AND METHODS: Thirty-one children, ranging from 5 to 17 years of age, with 32 discoid lateral menisci that underwent arthroscopic examination and MRI study were included. The clinical symtoms were reviewed by medical records. MR images were reviewed for the presence of meniscal tear and Wrisberg ligament, etc. Also, the absolute and relative thickness in anterior, posterior, mid-medial and mid-lateral portions were measured. The shape of the menisci were classified by the modified Hall's scheme. RESULT: The two most frequent complaints were pain (21 cases, 66.6%) and extension block (23 cases, 72.9%) . In 18 cases without surface tear, the most frequent clinical findings were extension block (14 cases, 78.8%) . The shape of the menisci correlated with the extension block. The mean thickness of the anterior portion of discoid lateral meniscus (7.12mm) in extension block (+) group was significantly larger than that (4.01mm) of the extension block (-) group (P=0.019) . The extension block was significantly higher in anterior asymmetric type (3/3) and slab type (19/21) than posterior asymmetric type (2/8) (P=0.003) . CONCLUSION: The main clinical symptoms in children with discoid meniscus were pain and extension block. The extension block seemed to strongly correlate with the shape of the meniscus. The thickness of the anterior portion of the discoid lateral meniscus is also considered a related mechanical factor that determines knee extension.

Closed Reduction of Mallet Fractures using Extension Black Kirshner Wire / 대한정형외과학회잡지

Operative repair of mallet fracture is a technically difficult operation because fracture of fragment and the difficulty in visualizing the articular congruity. The problems with these methods include soft tissue scar formation and subsequent joint stiffness. From January 1993 to April 1994, eight cases of mallet fingers with displaced large fracture fragment and/or subluxed distal phalanx were treated by closed reduction using extension-block Kirschner wire. The follow-up evaluation took place after a mean of 6 months. The results according to Crawford's criteria were four excellent, two good and two fair. This technique is simple, and easier than other techniques for reduction of mallet fractures, and is associated with a low morbidity.