Mallet Fracture

Shariatzadeh, Hooman

Volume 1, Issue 4 (11-2014) JROS 2014, 1(4): 0-0 | Back to browse issues page

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Shariatzadeh H. Mallet Fracture. JROS 2014; 1 (4)
URL: http://jros.iums.ac.ir/article-1-137-en.html

Mallet Fracture

Hooman Shariatzadeh

Department of Hand Surgery, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran

Keywords: Fractures, Bone, Therapeutics

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Abstract

© 0, Shafa Orthopedic Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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Dear Editor

Considering the interesting article in the last journal edition about PIP FX-DX, it seems necessary to pay more attention about its nearest joint, DIP dorsal fracture or mallet fracture. Traditionally, most of these types of injury are managed nonoperatively unless volar subluxation exists as a result of more than 40% dorsal base fractures (1). In the presence of large dorsal fragment volar subluxation could be seen after hyperextension of DIP joint and must be prevented, otherwise simple extension splinting for 4-6 weeks is an acceptable treatment modality. Alternative treatment is simple DIP pinning in extension in high demand patients or uncooperative ones. Main treatment controversy is presence of large dorsal fragment with or without volar subluxation, both operative and nonoperative treatments were reported with acceptable results (2).

Operative Treatment

Two mostly used operative techniques are open reduction and extension block pinning. Open reduction is technically difficult because of risk of thin skin problem and comminution of small dorsal fragment. Multiple dorsal H, Y or lazy-S incisions are used according to surgeon preference during this procedure and fixation achieved by k-wire or pull-out suture technique. Extension block pinning is a technique to reduce risk of open surgery in these types of injuries (3). A 0.035 or 0.045-inch k-wire is inserted into the head of middle phalanx in 45 degrees angulation to buttress distal fracture fragment and DIP joint fixed in extension by another pin for 4-6 weeks. Main indications are large dorsal fragment and palmar subluxation. As a result of joint transfixing, risk of permanent DIP motion limitation must be kept in mind (4). In conclusion, mallet fracture is a common traumatic hand lesion treated both operatively and nonoperatively with acceptable outcomes, although permanent dorsal lump and some residual loss of flexion or extension lag are two most permanent deficits of these lesions and patient must be informed about these frequent complications.

References

1. 1. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg Am. 1984;9(2):231-7. [PubMed]
2. 2. Bendre AA, Hartigan BJ, Kalainov DM. Mallet finger. J Am Acad Orthop Surg. 2005;13(5):336-44. [PubMed]
3. 3. Tetik C, Gudemez E. Modification of the extension block Kirschner wire technique for mallet fractures. Clin Orthop Relat Res. 2002;(404):284-90. [PubMed]
4. 4. Shariatzadeh H, Jafari D, Taheri H, Pahlevansabagh A, Najd-Mazhar F, Shakib Ghanizadeh A. Extension block pining for treatment of bony mallet finger. Med J Islam Repub Iran. 2009;23(1):42-7.

Subject: Knee surgery
Received: 2019/09/9 | Published: 2014/11/15

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