Arch Hand Microsurg.  2018 Dec;23(4):248-253. 10.12790/ahm.2018.23.4.248.

Anatomical Direct Reduction of Bony Mallet Finger Using Modified-Intrafocal Pinning Technique

• Kang SW
• Park JK
• Jung HS
• Cha JK
• Kim KJ

• KMID: 2427390
• DOI: http://doi.org/10.12790/ahm.2018.23.4.248

Abstract

PURPOSE
The purpose of this study was to evaluate the clinical results of anatomic reduction of bony mallet finger using modified-intrafocal pinning technique.
METHODS
From March 2014 to October 2017, 18 patients with bony mallet finger were treated with modified-intrafocal pinning technique. Kirschner-wire was used to directly reduction the bony fragment, and extension block pinning and distal interphalangeal joint fixation were additionally performed to minimize the loss of reduction. Postoperative pain, range of motion, and radiological evaluation were performed. Duration of bone healing, functional recovery and complication rate were evaluated and Crawford's criteria was used to determine functional outcome after surgery.
RESULTS
Bone union was achieved in all cases after a postoperative mean of 6 weeks (5-7 weeks). An average of 2.8° (0°-10°) extension loss occurred in all patients. All patients showed satisfactory joint congruency and reformation of the joint surface, the mean flexion angle of the distal interphalangeal joint at the final follow-up was 72.2° (70°-75°). According to Crawford's classification, 12 patients (66.7%) were excellent and 6 patients (33.3%) were good.
CONCLUSION
Modified-intrafocal pinning technique is a method of obtaining anatomical bone healing by directly reduction and fixation of the bony fragment. Combined with other conventional percutaneous pinning procedures, it is expected that good results can be obtained if applied to appropriate indications.

Keyword

Bony mallet finger; Direct reduction; Anatomical reduction

MeSH Terms

Classification
Fingers*
Follow-Up Studies
Humans
Joints
Methods
Pain, Postoperative
Range of Motion, Articular

Figure

• 

  Fig. 1 Bony mallet finger injury showing 47.1% of articular surface involvement.

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  Fig. 2 (A) After flexing the DIP joint to secure a space for reduction, it is necessary to reduce the fragments directly using the K-wire. (B) The fragment was fixed using a 0.7 mm K-wire or a 23-gauge needle. (C) Additional extension block pinning was performed. (D) The DIP joint was fixed using a K-wire on the long axis or side of the distal end of the fracture. DIP: distal interphalangeal, K-wire: Kirschner wire.

• 

  Fig. 3 Anatomical bone healing was achieved without intraarticular step-off by modified-intrafocal pinning technique. (A) A 22-year-old man has a bony mallet finger injury of left ring finger (joint involve 40%, Wehbé and Schneider's classification 1B). (B) A 23-year-old woman has a bony mallet finger injury of right little finger (joint involve 45%, Wehbé and Schneider's classification 1B). Preop: Preoperation, Postop: Postoperation.

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