Kemiksiz Çekiç Parmağın Splintleme ve Perkütan Pinleme Tedavileri: Retrospektif Klinik Çalışma

Yıl 2023, , 1 - 5, 16.04.2023

Selami Karadeniz , Alparslan Yurtbay

https://doi.org/10.46332/aemj.1019915

Öz

Amaç: Çekiç parmak ortopedi pratiğinde sıkça karşılaşılan tendon yaralanmasıdır. Bu çalışmada kemiksiz çekiç parmak tanısı alan hastalarda uyguladığımız Kirschner teli (K-teli) ile perkütan pinleme ve splint uygulamasının klinik sonuçları retrospektif olarak karşılaştırıldı.

Araçlar ve Yöntem: Çalışmaya 2011-2020 tarihleri arasında yaralanmanın ilk 7 gün içerisinde distal interfalengeal eklem bozukluğu olan 81 hasta dahil edildi. Ekstansiyon splinti 42 hastaya K-teli ile perkütan pinleme ise 39 hastaya uygulandı. Klinik değerlendirme Crawford değerlendirme kriterlerine göre yapıldı.

Bulgular: Ortanca takip süresi splint grubunda 17 ay iken, K-teli grubunda 16 ay idi (p=0.632). Her iki grupta gözlenen komplikasyonlar (p=0.107) arasında anlamlı bir fark yoktu. Her bir gruptaki ekstansiyon kaybı derecesindeki azalma ise istatistiksel olarak anlamlıydı (p<0.001 ve p<0.001). Tedavi öncesi ve sonrası ekstansiyon kayıpları arasında splint ve K-teli grubunda (sırasıyla; p=0.522 ve p=0.085) anlamlı bir fark bulunmadı. Tedavi bitiminde fleksiyon derecesi splint grubunda daha fazlaydı ve aralarındaki fark anlamlıydı (p<0.001). Gruplar arasında Crawford değerlendirme kriteri dağılımına göre anlamlı bir fark tespit edilmedi (p=0.859).

Sonuç: Sonuç olarak çekiç parmak tedavisinde konservatif ve cerrahi yaklaşım sonuçları başarılı ve benzerdir. Hastalara her iki tedavi seçeneği de sunularak uygulanabilir.

Anahtar Kelimeler

crawford kriterleri;, eğimli tokmak;, kirschner telleri, uzatma splintleme

Splinting and Percutaneous Pinning Treatments of Non-Bony Mallet Finger: A Retrospective Clinical Trial

Öz

Purpose: Mallet finger is a common tendon injury in orthopedic practice. In this study, the clinical results of Kirschner wire (K-wire) and percutaneous pinning and splint application in patients diagnosed with non-bony mallet finger were retrospectively compared.

Materials and Methods: The study included 81 patients with distal interphalangeal joint disorder within the first seven days of injury between 2011 and 2020. An extension splint was applied to 42 patients, and percutaneous pinning with K-wire was applied to 39 patients. Clinical evaluation was performed according to Crawford's mallet finger criteria.

Results: The median duration of follow-up was 17 months in the splint group and 16 months in the K-wire group (p=0.632). There was no significant difference between these groups regarding the complications observed (p=0.107). The decrease in extension was significant in both groups (p<0.001 and p<0.001). There was no significant difference between the groups regarding the pre- and post-treatment extension losses (p=0.522 and p=0.085, respectively). At the end of the treatment, the degree of flexion was higher in the splint group, and the difference between the groups was significant (p<0.001). There was no significant difference between the groups regarding the assessment based on Crawford criteria (p=0.859).

Conclusion: In conclusion, both conservative and surgical approaches for the treatment of mallet finger are successful, and the results are similar. Both treatment options may be offered to the patients.

Anahtar Kelimeler

crawford’s criteria;, extension splinting;, kirschner wires;, tendinous mallet

Kaynakça

• 1. McCue FC, Meister K. Common sports hand injuries. Sports Med. 1993;15(4):281-289.
• 2. Bloom JM, Khouri JS, Hammert WC. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013;132(4):560e-566e.
• 3. Jm A. Splint For Mallet-Finger. Br Med J. 1965;1(5432):444-444.
• 4. Vernet P, Igeta Y, Facca S, Toader H, Diaz JJH, Liverneaux P. Treatment of tendinous mallet fingers using a Stack splint versus a dorsal glued splint. Eur J Orthop Surg Traumatol. 2019;29(3):591-596.
• 5. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg Am. 1984;9(2):231-237.
• 6. Warren R, Norris S, Ferguson D. Mallet finger: a trial of two splints. J Hand Surg Am. 1988;13(2):151-153.
• 7. Kinninmonth A, Holburn F. A comparative controlled trial of a new perforated splint and a traditional splint in the treatment of mallet finger. J Hand Surg Am. 1986;11(2):261-262.
• 8. Altan E, Alp NB, Baser R, Yalçın L. Soft-tissue mallet injuries: a comparison of early and delayed treatment. J Hand Surg Am. 2014;39(10):1982-1985.
• 9. Hong IT, Baek E, Ha C, Han S-H. Long-term Stack splint immobilization for closed tendinous Mallet Finger. Handchirurgie· Mikrochirurgie· Plastische Chirurgie. 2020;52(3):170-175.
• 10. Fritz D, Lutz M, Arora R, Gabl M, Wambacher M, Pechlaner S. Delayed single Kirschner wire compression technique for mallet fracture. J Hand Surg Am. 2005;30(2):180-184.
• 11. 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.
• 12. Geyman JP, Fink K, Sullivan SD. Conservative versus surgical treatment of mallet finger: a pooled quantitative literature evaluation. J Am Board Fam Pract. 1998;11(5):382-390.
• 13. Stern PJ, Kastrup JJ. Complications and prognosis of treatment of mallet finger. J Hand Surg Am. 1988;13(3):329-334.