Extension Block Pinning of Mallet Fractures: Comparison Between Early and Delayed Surgery

Year 2022, , 30 - 34, 14.03.2022

Serkan Surucu , Mahmud Aydın

https://doi.org/10.18521/ktd.1024167

Abstract

Objective: The objective of this study was to compare the outcomes of individuals who had acute mallet fracture treatment early versus those who underwent delayed surgical treatment.
Methods: This was a retrospective cohort study in which all patients were skeletally mature and underwent closed extension pinning surgery for Doyle Type 4B mallet fractures. Crawford criteria were used to evaluate extension lag, loss of DIP joint flexion, and pain outcomes following surgery. All patients were evaluated clinically and radiographically.
Results: There were 16 females and 32 males with total of 48 patients in this study. The mean age at the time of surgery was 31.50 ± 9.75 years (range, 19-60 years). A total of 30 patients with early surgical treatment of mallet fractures and 18 patients with delayed surgical therapy were included in the study. There was no significant difference in the active flexion of the DIPJ, Crawford criteria (p=0.085, p=0.907, respectively), except for complication rates (p=0.045).
Conclusions: When compared to the early closed extension-block pinning technique, the delayed closed extension-block pinning technique yielded a satisfactory functional outcome in the treatment of mallet fractures.

Keywords

closed surgery, delayed surgery, Ishiguro technique, Mallet fracture

Supporting Institution

University of Missouri Kansas City

Project Number

20589519

Mallet Kırıklarında Ekstansiyon Blok Pinleme: Erken ve Gecikmeli Cerrahi Karşılaştırması

Abstract

Amaç: Bu çalışmanın amacı, erken dönem mallet kırığı cerrahisi yapılan hastalarla gecikmiş dönem cerrahi tedavi uygulanan hastaların sonuçlarını karşılaştırmaktı.
Gereç ve Yöntem: Bu retrospektif kohort çalışmaya Doyle Tip 4B mallet kırığı nedeniyle kapalı ekstansiyon-blok pinleme tekniği uygulanan, iskelet matürasyonu tamamlanmış erişkin hastalar dahil edilmiştir. Distal interfalangeal eklem ekstansiyon, fleksiyon kaybı ve cerrahi sonrası ağrı sonuçlarını değerlendirmek için Crawford kriterleri kullanıldı. Tüm hastalar klinik ve radyografik olarak değerlendirildi.
Bulgular: Bu çalışmada 48 hastadan 16'sı kadın, 32'si erkekti. Ameliyat sırasındaki ortalama yaş 31.50 ± 9.75 yıl (aralık, 19-60 yıl) idi. Mallet kırığı erken cerrahi tedavisi uygulanan 30 hasta ve cerrahi tedavisi gecikmiş 18 hasta çalışmaya dahil edildi. İki grup arasında distal interfalangeal eklem aktif fleksiyonu ve Crawford kriterleri (sırasıyla p=0.085, p=0.907) açısından anlamlı fark olmamasına rağmen komplikasyon oranları (p=0.045) ve ekstansiyon gecikmesi açısından istatistiksel olarak anlamlı fark saptandı.
Sonuç: Gecikmiş dönem kapalı ekstansiyon-blok pinleme tekniği, erken dönem kapalı ekstansiyon-blok pinleme tekniği ile karşılaştırıldığında, mallet kırıklarının tedavisinde tatmin edici fonksiyonel sonuç vermiştir.

Keywords

Mallet kırığı, kapalı cerrahi, Ishiguro tekniği, gecikmiş cerrahi

Project Number

20589519

References

• Referans1. Agarwal S, Akhtar NM. Closed Extension-Block Pinning for Management of Mallet Fracture - A Case Report Based Description. J Orthop Case Rep. 2012;2(3): 17-20.
• Referans2. Asano K, Inoue G, Shin M. Treatment of chronic mallet fractures using extension-block Kirschner wire. Hand Surg. 2014;19(3): 399-403.
• Referans3. Bachoura A, Ferikes AJ, Lubahn JD. A review of mallet finger and jersey finger injuries in the athlete. Curr Rev Musculoskelet Med. 2017;10(1): 1-9.
• Referans4. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg Am 1984;9: 231–237.
• Referans5. Doyle J. Extensor tendons: acute injuries. In: Green DP, Hotchkiss RN, Pederson WC, editors. Operative hand surgery. 4th ed. Churchill Living- stone: Philadelphia; 1999. p. 1950–70.
• Referans6. Han HH, Cho HJ, Kim SY, Oh DY. Extension block and direct pinning methods for mallet fracture: A comparative study. Arch Plast Surg. 2018;45(4): 351-356.
• Referans7. Hofmeister EP, Mazurek MT, Shin AY, Bishop AT. Extension block pinning for large mallet fractures. J Hand Surg Am. 2003;28(3): 453-459.
• Referans8. Ishiguro T, Itoh Y, Yabe Y, Hashizume N. Extension block with Kirschner wire for fracture dislocation of the distal interphalangeal joint. Tech Hand Up Extrem Surg 1997;1: 95–102.
• Referans9. King H, Shin S, Kang E. Complications of operative treatment for mallet fractures of the distal phalanx. J Hand Surg Br. 2001;26: 28-31.
• Referans10. Kluijfhout WP, Tutuhatunewa ED, van Olden GDJ. Plate fixation of clavicle fractures: comparison between early and delayed surgery. J Shoulder Elbow Surg. 2020;29(2): 266-272.
• Referans11. Konrath G, Karges D, Watson JT, Moed BR, Cramer K. Early versus delayed treatment of severe ankle fractures: a comparison of results. J Orthop Trauma. 1995;9(5): 377-380.
• Referans12. Kootstra TJM, Keizer J, van Heijl M, Ferree S, Houwert M, van der Velde D. Delayed Extension Block Pinning in 27 Patients with Mallet Fracture. Hand (N Y). 2021;16(1): 61-66.
• Referans13. Schneider LH. Fractures of the distal interphalangeal joint. Hand Clin. 1994;10(2): 277-285.
• Referans14. Wada T and Oda T. Mallet fingers with bone avulsion and DIP joint subluxation. J Hand Surg Eur Vol. 2015;40(1): 8–15.
• Referans15. Wehbé MA, Schneider LH. Mallet fractures. J Bone Joint Surg Am. 1984;66(5): 658-669.
• Referans16. Yoon JO, Baek H, Kim JK. The Outcomes of Extension Block Pinning and Nonsurgical Management for Mallet Fracture. J Hand Surg Am 2017;42: 387.e1–387.e7.