gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
72. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 94. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 49. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

22. - 25.10.2008, Berlin

An almost forgotten technique for the treatment of mallet finger fracture

Meeting Abstract

  • J. Widmer - Kantonsspital Olten, Chirurgische Klinik, Olten, Switzerland
  • A. Missbach-Kroll - Kantonsspital Olten, Chirurgische Klinik, Olten, Switzerland
  • T. Sanchez - Kantonsspital Olten, Handchirurgie, Olten, Switzerland
  • L. Meier - Kantonsspital Olten, Chirurgische Klinik, Olten, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 94. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 49. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 22.-25.10.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocPO22-879

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dkou2008/08dkou773.shtml

Veröffentlicht: 16. Oktober 2008

© 2008 Widmer et al.
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Gliederung

Text

Background: Mallet injuries are avulsions of the terminal extensor tendon, with or without a bony fragment, resulting in a characteristic axial loading or a forceful flexion of the extended digit. Clinically there is a sudden loss of extension of the distal interphalangeal (DIP) joint. In nonsurgical treatment by immobilisation, complications as joint stiffness, skin maceration, loss of extension and hyperextension deformity have been reported. On the other hand most of the surgical techniques have the disadvantages of open incisions. The inclusion criteria for surgery by this technique are a closed, displaced mallet fracture involving radiologically 25% or more of the articular surface or a fracture associated with DIP joint subluxation.

Methods: The extension block fixation technique was first described by Ishiguro et al. in 1988. After the digit is anesthetized via a digital block, DIP joint is maximally flexed. Using fluoroscopic imaging, a Kirschner wire is inserted percutaneously through the extensor tendon in the distal portion of the middle phalanx. The wire provides an extension block for the bony fragment when the DIP joint is extended to reduce the fracture. After obtaining an anatomic reduction, the distal interphalangeal joint is immobilized with a second wire placed longitudinally across the joint to maintain the extension and reduction. A removable postoperative extension splint was placed to protect the pins and to block DIP motion for 2 weeks. Both wires are removed after 4–6 weeks, once there is radiological evidence of healing. A total of 7 patients with 8 mallet fractures of the distal phalanx were retrospectively reviewed to determine the results of treatment, range of motion and associated complications.

Results: There were 6 men and 1 woman, with an average age of 35 years (range, 18–47 years) treated between February 2007 and January 2008, all ambulant. The average fracture size was 40% of the joint. The right hand was involved in 4 cases, the left in 3. In 4 cases the initial injury was sustained during sporting. The K-wires were removed after 4–6 weeks. In one patient the wires were removed early due to an infection. We obtained in the vast majority excellent results concerning the range of motion and functionality of the digit. A Sudeck’s Syndrome occurred in one case. There were no nonunions, malunions or osteomyelitis.

Conclusions: The technique is easy to perform and an effective method of treatment for displaced mallet finger fractures with satisfactory results. It is minimally invasive and it allows an early mobilisation making it very suitable for the patients. The duration of operation is very short as well as the radiation exposure.