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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Tips under the Skin: a Simple but Great Modification of Extension Block Pinning for Mallet Fractures

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  • presenting/speaker Seung-Han Shin - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  • Yong-Suk Lee - Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, South Korea
  • Jin-Woo Kang - Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, South Korea
  • Wonwoo Kang - Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, South Korea
  • Yang-Guk Chung - Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1171

doi: 10.3205/19ifssh0564, urn:nbn:de:0183-19ifssh05640

Published: February 6, 2020

© 2020 Shin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The pins exposed out of the skin keep the patients from washing their hands after the surgery for mallet fractures. The aim of this study was to report the feasibility of placing pin tips under the skin in extension block surgery for mallet fractures.

Methods: We buried tips of all pins under the skin while performing extension block pinning for mallet fractures. 14 mallet fracture patients treated with such a modified procedure were reviewed. To prevent subsidence, the pins for extension block and distal interphalangeal (DIP) joint transfixation were inserted until it just penetrated the volar cortex and to the subchondral bone of the middle phalangeal base, respectively. Then the pins were cut shortly enough to place the tips under the skin. Postoperatively a bulky dressing was applied with or without an aluminum finger splint. The patients were allowed to wash their hands 4-5 days after the surgery, without any dressing or splinting. The pins were removed mean 8 weeks after the surgery.

Results and Conclusions: Solid union was achieved in all 14 fractures. No pull-out or subsidence of the pin was observed. No patient developed infection or other pin-related complications. Mean extension lag at final follow-up was 4° and mean DIP flexion was 75°. Placing pin tips under the skin appears to be a feasible modification in extension block surgery for mallet fractures. Our modification allows patients to wash their hands and keep their bread-an-butter jobs soon after the surgery.