Closed Extension Block Technique for Treatment of Osseous Mallet Injury

Abstract

Objectives: We analyzed the clinical and radiological outcomes of percutaneos extension block technique for treatment of osseous mallet injury. Methods: We included 36 patients who had osseous mallet finger ≥ 20% articular surface involvement. We controlled 29 men, 7 women followed mean 18,5 ( Range 8 – 24) months.Radiologic evaluation was made according to the Doyle classification and 25 injuries were classified type IVb, 11 injuries were classified type IVc. Final evaluation were made according to Crawford evaluation criteria and distal interphalangeal joint motion.Results: The preoperative avarage articular surface involvement was 39,7% ( Range 20 – 60 ). The DIP joint subluxation was seen in 6 patients who had ≥50% articular surface involvement. Clinical results, according to the Crawford criteria, were excellent in 30 ( 83,3% ) patients, good in 4 patients ( 11,1% ), moderate in 2 patients ( 5,5% ). The average extension lag was 3,1° (0°to 17°), and the average final active flexion of DIP joint was 75,1° (50° to 80°). Bone union was showed in all cases radiographically at the final control. Conclusion: The extension block technique is a minimal invasive treatment technique. This technique has decreased the complications of the open surgical treatments. This technique when properly applied has been given functionally satisfactory results. The experience of the surgeon is very effective over the result of the patients.

Keywords

• Mallet Finger Surgery, Extension Block.

References

1. Wehbé MA, Schneider LH. Mallet fractures. J Bone Joint Surg 1984;66(A):658-69.
2. Lubahn JD. Mallet finger fractures: a comparison of open and closed technique. J Hand Surg 1989:14(A):394-6.
3. Stark HH. Gainor BJ. Ashworth CR. et al. Operative treatment of intra- articular fractures of the dorsal aspect of the distal phalanx of digits. J Bone Joint Surg 1987:69(A):892-6.
4. Kang HJ, Shin SJ, Kang ES. Complications of operative treatment for mallet fractures of the distal phalanx. J Hand Surg 2001, 26(B): 28-31.
5. Ishiguro T, Inoue K, Matsubayashi T, Ito T, Hashizume N. A new method of closed reduction for mallet fractures. J Jap Soc Surg Hand 1988;5:444-7.
6. Grundberg AB, Reagan DS. Central slip tenotomy for chronic mallet finger deformity. J Hand Surg 1987;12(A):545-7.
7. Evans D, Weightman B. The Pipflex splint for treatment of malletfinger. J Hand Surg 1988;13(B):156-8.
8. Darder-Prats A, Fernandez-Garcia E, Fernandez-Gabarda R: Treatment of mallet finger fractures by the extension-block K-wire technique. J Hand Surg 1998; 23(B): 802-5

9. Hofmeister EP, Mazurek MT, Shin AY, Bishop AT. Extension block Pinning for Large Mallet Fractures. J Hand Surg 2003,28(A):453-9
10. Rayan GM, Mullins PT. Skin necrosis complicating mallet finger splinting and vascularity of the distal interphalangeal joint overlying skin. J Hand Surg l987,12(A): 548-52.
11. Abouna JM, Brown H. The treatment of mallet finger: the results in a series of 148 consecutive cases and a review of the literature. Br J Surg 1968;55:653-67.
12. Mikic Z, Helal B. The treatment of the Mallet finger by the Oakley splint. The Hand 1974;6:76-81.
13. Stern PJ, Kastrup JJ. Complications and prognosis of treatment of mallet finger. J Hand Surg 1988;13(A):329-34.
14. Pegoli L, Toh S, Arai K, Fukuda A, Nishikawa S, Vallejo G. The Ishiguro extension block technique for the treatment of mallet finger fracture: indications and clinical results. J Hand Surg 2003,28(B):1:15-7