Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

INTRODUCTION: Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. MATERIAL AND METHODS: We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. RESULTS: When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). CONCLUSIONS: We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

INTRODUCCIÓN: Una complicación común del pull-put tradicional es la necrosis del sitio del botón en la yema del dedo. Zhang describió una forma alternativa de anclar el cerclaje al clavo de Kirschner para aliviar la presión en la yema del dedo. Describe el uso de cerclaje de alambre para la reducción de fracturas. El objetivo de este trabajo es realizar una comparación entre el alambre y el nailon utilizando la técnica de extracción de Zhang. MATERIAL Y MÉTODOS: Realizamos un estudio de cohorte comparando la técnica de nailon versus alambre en Zhang. Comparación de satisfacción cosmética, rigidez, dolor residual y escala de Crawford. RESULTADOS: Al comparar los resultados entre ambos grupos, no encontramos diferencias estadísticas en la satisfacción cosmética (p = 0.285), rigidez (p = 0.460) y dolor residual (p = 1.000), complicaciones generales (p = 1.000) o escala de Crawford (p = 1.000). Solo encontramos una diferencia estadística significativa en el dolor al retirar el cerclaje, siendo mayor en el Grupo B (p = 0.008). CONCLUSIONES: No encontramos diferencias significativas en los resultados entre el cerclaje de nailon y el cerclaje con alambre. Pero, al momento de retirarlo, los pacientes experimentan menos dolor. Tipo de estudio: terapéutico Nivel de evidencia III.

Stack Splinting Versus Kirschner Wire Treatment in Acute Closed Mallet Finger Doyle I.

Introduction: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is still unclear. Objective: To evaluate the treatment efficacy of Stack Splinting compared to a Kirschner wire immobilization of acute closed mallet finger Doyle I. Methods: From March 2019 to February 2020, 41 patients with acute close mallet finger Doyle I were treated; 19 patients were treated with Kirschner wire and 22 with Stack splinting for a mean of 6 weeks. The average patient age at the time of the injury was 43 years. Results: Twenty-eight males and 13 females were in this study. Among them, 17 patients were injured in the little finger, 15 in the middle finger, and 9 in the ring finger. Twenty-seven of injuries suffered an aggression, 11 from falling, and 3 from sports injuries. All the fingers had typical mallet malformation. Seventeen patients treated with Kirschner wire completed the treatment with full recovery, only 7 patients treated with Stack splint completed the treatment and 15 treated with Stack splint had relapse on mallet injury. Conclusion: Kirschner wire treatment is a simple procedure, and proves in this study that has better results in patients with acute closed mallet finger Doyle I compared to Stack splint.

Introduction: Les doigts à gâchette (ou à ressaut) sont courants et généralement traités avec prudence. Diverses analyses systématiques ont constaté un manque de données probantes sur la prise en charge optimale, qui n'est pas toujours claire. Objectif: Évaluer l'efficacité du traitement par attelle de Stack par rapport à l'immobilisation par broches de Kirschner en cas de doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle. Méthodologie: Entre mars 2019 et février 2020, 41 patients d'un âge moyen de 43 ans au moment de la lésion ont présenté un doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle et ont été traités. Ainsi, 19 ont été traités par une broche de Kirschner et 22, par une attelle de Stack, pendant une période moyenne de six semaines. Résultats: Au total, 28 hommes et 13 femmes ont participé à cette étude. De ce nombre, 17 patients ont subi une blessure de l'auriculaire, 15, du majeur, et neuf, de l'annulaire. Une agression avait causé 27 des blessures, une chute en avait causé 11 et des blessures sportives, trois. Tous les doigts présentaient la malformation à gâchette classique. Au total, 17 patients traités par une broche de Kirschner ont terminé le traitement et se sont pleinement rétablis, mais seulement sept patients ayant eu une attelle de Stack ont terminé le traitement, et 15 d'entre eux ont vécu une rechute. Conclusion: Le traitement par broche de Kirschner est une intervention simple, et la présente étude démontre qu'il donne de meilleurs résultats que l'attelle de Stack chez les patients ayant un doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle.

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.

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients.

OBJECTIVES: 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.

OBJETIVO: 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.

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.