gms | German Medical Science

Objectives/Interrogation: It is common for the patient with mallet fracture not coming to the clinic immediately after the injury. Purpose of this study was to investigate the surgical outcome for bony mallet fingers with delayed presentation, and to compare the outcomes between two methods.

Methods: Thirty-one bony mallet fingers treated 35 days or later from the injury with open reduction and internal fixation were included in this retrospective study. Cases with open fractures, multiple finger and/or joint injuries, fracture of the thumb, follow up shorter than 60 days, and reoperation of cases initially treated elsewhere were excluded. There were 18 males/13 females, 5 index/8 middle/11 ring/7 little fingers. Age ranged from 10 to 74 (average 35.3) years old. Intervals from injury to operation were 36 to 122 (average 56.5) days. Fractures were internally stabilized with open Ishiguro's method in 12, and with a hook plate and Kirshner wires in 19.

Results and Conclusions: Active flexion/extension of the DIP joint in open Ishiguro's method and the hook plate group was 44.8±15.2/-12.2±9.7 degrees and 51.8±14.6/-11.9±8.4 degrees respectively. Off set at the DIP joint was 0.63±0.30mm in open Ishiguro's method and 0.39±0.48mm in the hook plate group. The hook plate group tend to be better at active flexion and reduction, however there were no significant differences between two groups. Two cases in the open Ishiguro's group and three in the hook plate group had residual volar subluxation of the DIP joint. All fractures healed at final follow up.

Both groups achieved bony union with usable range of motion. Postoperative volar subluxation remains a problem to be addressed. Further study is needed to clarify better solution for the treatment of bony mallet fingers with delayed presentation.