ABSTRACT
Introduction: and importance: Chronic mallet finger resulted in mallet deformity or swan neck deformity are caused by imbalance of flexor and extensor mechanism. We tried to offer a reliable option of treatment by terminal tendon reconstruction using needle passer to exchange the use of K-wire which resulted in great result within 3 months of follow up. Case presentation: 36 years old male with previous history of several trauma on his right arm and hand about three months ago; consists of distal phalangeal fracture of right index finger, right fifth metacarpal fracture, proximal phalanx fracture of right small finger, and right shaft radius fracture. After 3 months since initial injury, we focused on the right index finger which suffered in a swan neck deformity. The patient was unable to reach maximum flexion of his right index finger. We performed terminal extensor tendon reconstruction with great result after three months of follow up. Clinical discussion: Chronic mallet finger has many different techniques of surgical intervention, such as Fowler's tenotomy, tenodermodesis, spiral oblique retinacular ligament (ORL) reconstruction, and arthrodesis of distal interphalangeal (DIP) joint. The surgery was indicated after failure of 4 weeks finger splinting to correct the swan neck deformity. The aim of surgery was to improve finger function, restore normal active-passive flexion of proximal (PIP) and distal interphalangeal (DIP) joint by rebalancing the extensor mechanism of finger, relieve pain, and improve cosmetic appearance. Conclusion: Terminal extensor tendon reconstruction is a simple, reproducible and reliable option of surgical treatment in chronic mallet finger case. At minimum follow up of 3-months after surgery has showed a satisfactory result.
ABSTRACT
INTRODUCTION: Cubitus varus deformity after malunited supracondylar humerus fracture has various surgical techniques, implant configurations, and approaches. We describe a combination of French and Dome osteotomy and novel internal fixation technique to deliver an easy, safe, fast and reproducible result based on the current best evidence. PRESENTATION OF CASE: Two cases of malunited supracondylar humerus are described. The first case involves a 3-year-old girl who presented with outstretched and supinated left arm after falling during bike riding 3 weeks earlier. We found no abnormality in radial and median nerve function, but the left arm radiographs showed a callus formation and the early stages of a malunited fracture of the supracondylar humerus. We waited two months for further radiographic evaluation and the radiographs showed the malunited supracondylar humerus with elbow flexion of only 105° and elbow hyperextension of 20°. The cubitus varus was recorded with clinical carrying angle of varus 10°. We used a combination of original French and Dome osteotomy, lateral approach, and our novel fixation technique with excellent results. The second case involved a 8-year-old boy with malunited right elbow and the surgery was done in the same manner, with the result of restoration to normal elbow range of motion. We also assessed the pain score and disabilities of the arm, shoulder and hand (DASH) score and recorded satisfactory results. CONCLUSIONS: The combination of French and Dome osteotomy for treatment of cubitus varus deformity can provide an easy, safe, and reproducible result.
