ObjectiveTo compare the effectiveness between micro-anchor repair and modified pull-out suture in the treatment of mallet fingers. MethodsBetween June 2010 and March 2011, 33 patients with mallet fingers were treated by micro-anchor repair method (n=18, group A) and by modified pull-out suture method in which the broken tendons were sutured with double metal needle Bunnell’s suture and a knot was tied palmarly (n=15, group B). There was no significant difference in age, gender, and disease duration between 2 groups (P gt; 0.05). ResultsThe operation time was (62.5 ± 3.1) minutes in group A and (65.0 ± 4.6) minutes in group B, showing no significant difference (t=1.85, P=0.07). The treatment expense in group A [(8 566.2 ± 135.0) yuan] was significantly higher than that in group B [(5 297.0 ± 183.5) yuan] (t=58.92, P=0.00). Incision infection occurred in 2 cases of group A and 1 case of group B; the other patients obtained healing of incision by first intention. Relapsed mallet finger was observed in 1 case of group B. All patients in 2 groups were followed up 12-21 months. According to the Crawford functional assessment system, the results were excellent in 5 cases, good in 10 cases, fair in 2 cases, and poor in 1 case at the last follow-up with an excellent and good rate of 83.3% in group A; the results were excellent in 4 cases, good in 9 cases, fair in 1 case, and poor in 1 case with an excellent and good rate of 86.7% in group B. There was no significant difference in the excellent and good rate between 2 groups (χ2=0.23, P=0.97). ConclusionBoth micro-anchor repair and modified pull-out suture are simple and effective methods in the treatment of mallet finger. But compared with micro-anchor repair, pull-out suture has lower expense.
Objective To compare differences in the cl inical outcomes between percutaneous pinning with plaster spl int and open reduction and pull ing out wire in the treatment of mallet fingers. Methods From December 2002 to September 2007, 72 patients with mallet fingers were treated. They were divided into two groups: group A and group B. In group A, 38 patients were treated by open reduction and pull ing out wire, 34 males and 4 females, aged (26.0 ± 8.5) years. Among them, 2 patients were injured in the index finger, 11 in the middle finger, 18 in the ring finger and 7 in the l ittle finger. Thirtythreepatients suffered from sports injuries, 5 from fall ing wounds. The average time between the injury and the surgery was(6.1 ± 3.1) days. In group B, 34 patients were treated by percutaneous pinning with plaster spl int, 26 males and 8 females, aged (28.1 ± 10.7) years. Among them, 1 patient was injured in the index finger, 9 in the middle finger, 15 in the ring finger and 9 in the l ittle finger. Thirty-one patients suffered from sports injuries, 3 from fall ing wounds. The average time between the injury and the surgery was (6.3 ± 3.6) days. All the fingers had typical mallet malformation, and X-ray films showed avulsed fractures of distal-segment phalanxes at the dorsal basilar part. Results The operation time was (61.8 ± 12.8) minutes in group A and (7.0 ± 2.6) minutes in group B. All patients in both groups were followed up for 6-24 months (11.9 months on average in group A and 13.2 months in group B). In group A, apart from 3 patients who had flap necrosis and infection, all the other patients obtained heal ing by first intention. One patient had palmar skin ulcer at 6 days after the operation and healed after proper treatment. Thirty-six patients gained bone union at (47.6 ± 8.7) days postoperatively and 2 patients had pseudarthrosis, which improved after reconstruction of the extensor tendon attachment point. According to the total active movement (TAM) functional assessment system, 10 cases were e cellent, 18 good, 8 fair and 2 poor, with the choiceness rate of 73.7%. In group B, all incisions obtained heal ing by first intention without pin-track infection, flap necrosis and migration of the pins and gained bone union at (27.7 ± 3.9) days after the operation. According to the TAM functional assessment system, 19 cases were excellent, 13 good and 2 fair, with the choiceness rate of 94.1%. There were significant differences between the two groups in operation time, compl ications, heal ing time and choiceness rate (P lt; 0.05). Conclusion Percutaneous pinning with plaster spl int is simple in operation and has smaller incisions and fewer compl ications compared with open reduction and pull ing out wire, andproves to be a useful way in the treatment of mallet fingers.
Objective To evaluate the clinical results of mallet finger accompanied by avulsional fracture treated with Ishiguro method. Methods Twenty-seven patients suffering from mallet finger accompanied by avulsional fracture weretreated with Ishiguro method or its modified method. During the operation, a blocking pin was inserted percutaneously with DIP flexed, then the DIP was fixed at a position of full extension with another Kirschner wire. When the fracture fragment was big with rotation displacement, a third Kirschner wire could be used to correct the displacement and fix fracture. Results The patients were followed up 2 months to 6 years and 6 months with an average of 9.3 months postoperatively. Andthe clinical results were evaluated with the modified Crawford’s criteria, including DIP pain, range of motion and pinch power. The rate of bone union was 100%. The results were excellent in 7 patients, good in 11 patients, moderate in 8 patients and poor in 1 patient. After operation, the range of flexion was 54.19°±14.45° , while the range of extension was －4.96°±9.27°. The X-ray sign of slight osteoarthritis could be seen in one patient. [WTHZ]Conclusion Ishiguro method is simple, effective and less invasive. It is suitable for treatment of mallet finger accompanied by avulsional fracture.
Through dissection of 12 fresh finger specimens, the anatomy of the distal part of dorsal aponeurosis and its function was closely observed. A direct reparative procedure of the terminal tendon by using tendon flap graft was deseribed for the treatment of chronic mallet finger deformity. Correction of deformity, restoration of active motion of DIP and avoidance of residual pain were observed in three clinical cases.
Objective To evaluate the short-term effectiveness of Kirschner wire (K-wire) elastic fixation in the treatment of Doyle type Ⅰ and Ⅱ mallet finger. Methods Between July 2016 and March 2017, 18 patients with Doyle type Ⅰ and Ⅱ mallet finger were treated. There were 12 males and 6 males, with an average age of 45 years (range, 16-61 years). The index finger was involved in 2 cases, the middle finger in 3 cases, the ring finger in 10 cases, and the little finger in 3 cases. The interval from injury to operation ranged from 2 hours to 45 days (median, 5.5 hours). There were 8 patients of closed wound and 10 patients of open wound. Fourteen patients were simply extensor tendon rupture and 4 were extensor tendon rupture complicated with avulsion fracture. The distal interphalangeal joints (DIPJ) of injured fingers were elastically fixed with the K-wire at mild dorsal extend position. The K-wire was removed after 6 weeks, and the functional training started. Results The operation time was 34-53 minutes (mean, 38.9 minutes). Patients were followed up 3-8 months (mean, 5 months). All incisions healed primarily and no K-wire loosening or infection happened during the period of fixation. All mallet fingers were corrected. The range of motion (ROM) in terms of active flexion of injured DIPJ was (75.83±11.15)° at 6 weeks after operation, showing significant difference when compared with the normal DIPJ of contralateral finger [(85.28±6.06)°] (t=3.158, P=0.003). The ROM in terms of active flexion was (82.67±6.78)° in 15 patients who were followed up at 8 months after operation, showing no significant difference when compared with the normal DIPJ of contralateral finger [(86.00±5.73)°] (t=1.454, P=0.157). After the removal of K-wire at 6 weeks, visual analogue scale (VAS) score of active flexion and of passive flexion to maximum angle were 1.78±0.88 and 3.06±1.06, respectively. According to the total active motion criteria, the effectiveness was rated as excellent in 10 cases, good in 5 cases, moderate in 2 cases, and poor in 1 case, and the excellent and good rate was 83.33%. The patients’ satisfaction were accessed by Likert scale, which were 3-5 (mean, 4.2). Conclusion K-wire elastic fixation in the treatment of Doyle typeⅠand Ⅱ mallet finger can repair the extensor effectively, correct the mallet finger deformity, and also be benefit for the flexion-extension function restoration of DIPJ.