"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.

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.

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.

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.

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.

Operative Treatment of the Bony Mallet Finger / 대한정형외과학회잡지

Although there are various methods of operative treatment for hony mallet finger, the operative technique is not so easy and complications such as joint stiffness, sott tissue prohlems, infection, change of nail shape and arthrosis are common. The authors performed operations for 26 cases of hony mallet fingers, fixing the hony frapment by Kirschner wire, pull-out wire suture and miniscrew respectively, from Jan. l988 to Jun. l996. The results were as follows. l. According to Niechajev's classification. there were 3 cases of type B, 7 cases of type C, l4 cases of type D, and 2 cases of type E. And 11 cases were accompanied hy crushing injury. 2. Involved fingers were third finger in 11cases, fit'th finger in 7 cases, fourth finger in 5 cases, second finger in 2 cases. and thumb in I case. 3. The hony mallet finger was caused hy occupational injury in l6 cases, direct blow in 7 cases and sports injury in 3 cases. 4. The fractured fragment was fixed hy Kirschner wire in 9 cases, by pull-out suture in 9 cases and by miniscrew in 8 cases. 5. The results were evaluated hy Kanies scale. Sixteen cases had satisfactory results. Seven cases (87.5%) were satisfactory in miniscrew fixations. 5 cascs (55.6%) in pull-out wire suture methocls and 2 cases (22.2%) in Kirschner wire tixations. 6. The complications were joint incongruity in 4 cases, dorsal prominece in 6 cases, painful limitation of motion in 2 cases which were treated by arthrodesis, pin site infection in 2 cases and hreakage of wire suture in 1 case. 7. The miniscrew fixation offered relatively firm fixation, low complication rate, and good results. so it can be considered as one of the good methods of treatment for hony mallet finger.