Mini-Open Reduction and Extension Block Pinning for Irreducible Mallet Fractures: A Minimally Invasive Technique for Anatomical Reduction

2021 ◽  
Vol 26 (03) ◽  
pp. 425-431
Author(s):  
Seung-Han Shin ◽  
Joonhyung Cho ◽  
Ji-Won Lee ◽  
Yang-Guk Chung
Keyword(s):  
Open Reduction ◽  
Articular Surface ◽  
Fracture Site ◽  
Invasive Technique ◽  
Anatomical Reduction ◽  
Fracture Fragment ◽  
Percutaneous Procedures ◽  
Mallet Fracture ◽  
Mini Open

Background: Dorsal rotation or persistent displacement of the fracture fragment is frequently encountered in extension block pinning for mallet fractures. We reviewed nine irreducible mallet fracture patients treated with mini-open reduction and extension block pinning. Methods: A small V-shaped incision was made on the fracture gap when there was persistent displacement of fracture fragment despite closed maneuvers and percutaneous procedures while performing extension block pinning. Soft tissue or granulation tissue hampering reduction was removed through the incision. Anatomical reduction was guided with a freer elevator. The incision was closed by distal interphalangeal joint transfixation in extension without any suture. Pin tips were buried under the skin. The incision and pin entry sites were covered with skin adhesive, and the patients were allowed to wash their hands 1–2 days after the surgery. No splint was applied postoperatively. Mean follow-up period was 13 months. Results: Anatomical reduction was achieved in 7 out of 9 patients. In the rest 2 patients, postoperative step-off of the articular surface at the fracture site was less than 0.5 mm. Solid union was achieved in all cases. The mean extension lag at final follow-up was 0°. No patient developed postoperative external bleeding or other complications in the incision site or the pin site. Conclusions: Mini-open reduction and extension block pinning appears to be a good option for irreducible mallet fractures, which improves reduction quality and patients’ convenience.

Juvenile fracture of tillaux. A distal tibial epiphyseal fracture

1989 ◽  
Vol 79 (6) ◽  
pp. 295-299 ◽  
Author(s):  
WH Simon ◽  
R Floros ◽  
H Schoenhaus ◽  
RM Jay
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Skeletal Maturity ◽  
Functional Results ◽  
Anatomical Reduction ◽  
Fracture Fragment ◽  
Reduction Techniques ◽  
Tibial Epiphysis ◽  
Tillaux Fracture

The juvenile fracture of Tillaux is a Salter-Harris type III fracture of the distal tibial epiphysis. The mechanism of injury is an external rotational force of the foot. The fracture fragment is avulsed from the anterolateral aspect of the distal tibial epiphysis by the anteroinferior tibiofibular ligament. Treatment is based on the amount of displacement after closed reduction techniques are attempted. If complete anatomical reduction cannot be obtained, the authors recommend open reduction with internal fixation. The method of internal fixation should be based on the skeletal maturity of the distal tibial epiphysis. The prognosis usually is good if anatomical reduction is performed. The most serious complication reported is pain and stiffness secondary to articular incongruity following inadequate closed reduction techniques. The case of a 14-year-old girl with a juvenile Tillaux fracture treated by open reduction with excellent functional results at 11 months follow-up was presented.

scholarly journals INTERNAL FIXATION OF TYPE I CAPITELLUM FRACTURE WITH HEADLESS SCREWS: A CASE REPORT

2021 ◽  
Vol 10 (2) ◽  
pp. 70
Author(s):  
Charlie Sanjaya ◽  
I Ketut Gede Arta Bujangga
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Fracture Site ◽  
Humeral Fractures ◽  
Anatomical Reconstruction ◽  
Type I ◽  
Rigid Fixation ◽  
Distal Humeral Fractures ◽  
Capitellum Fracture

Background: Capitellum fractures are relatively rare. Distal humeral fractures that include capitellum and trochlea constitute approximately 6% of all distal humeral fractures and 1% of all elbow fractures. Despite the rarity of these injuries, an increasing number of clinical series have emerged, enhancing our understanding of these fractures.Case Report: A 26-year-old woman came to the emergency department with complaints of swelling and localized pain on the lateral side of her left elbow 2 hours after she fell off her motorcycle. Routine imaging such as plain radiographs and computed tomography scanning confirmed the fracture. She underwent open reduction and internal fixation surgery, stabilization of articular fragments with headless screws, and was fixated by a back slab and arm sling. The patient was also encouraged to do early elbow mobilization to avoid contractures and joint stiffness, routine follow-up every two weeks for a ROM evaluation. Preoperative Mayo Elbow-Performance Index score (MEPI) was 15, and postoperative 100.Discussion: The aim of capitellum fracture treatment is anatomical reconstruction and fixation to reduce the risk of non-union. In this case, we performed open reduction, secured two headless screws, which allow rigid fixation at the fracture site, provide fracture site compression through variable thread pitch design, and remained not removed later. These screws are suitable for use in anteroposterior and posteroanterior directions.Conclusion: The patient at two months follow-up has shown significant improvement. Accurate reduction, stable fracture fixation, and early postoperative mobilization were reported to provide good results with a MEPI score of 100.

scholarly journals Conservative Treatment of Chronic Mallet Fracture Non-union after Failed Pin Fixation

2020 ◽  
Vol 3 (1) ◽  
pp. 25-28
Author(s):  
Hara A
Keyword(s):  
Conservative Treatment ◽  
Articular Surface ◽  
Functional Results ◽  
Fracture Site ◽  
Distal Phalanx ◽  
Joint Surface ◽  
Mallet Finger ◽  
Non Union ◽  
Mallet Fracture ◽  
Pin Fixation

Introduction: Operative treatment of mallet finger fractures is generally recommended for patients in whom more than one-third of the articular surface is involved with volar subluxation. We present a case of conservative treatment with chronic nonunion of a mallet finger fracture after failed mallet finger surgery. Presentation of Case: A 16-year-old boy presented with a bony fragment (mallet formation) of his left long finger. The fragment occupied 40% of the articular surface, with volar subluxation of the distal phalanx. Percutaneous needle curettage of the fracture site and pinning were performed. Six weeks later, the fragment was displaced and had rotated. Hence, all the pins were removed, and a splint was applied. The fracture displayed nonunion and volar subluxation of the distal phalanx. The patient continued with the splinting, and the fracture finally healed. At 27 months after the surgery, radiological examination showed very good remodeling of the distal interphalangeal joint surface with anatomic joint congruence. Functional results at 27 months were good according to Crawford’s classification. Conclusion: Chronic nonunion of a mallet finger can be cured conservatively even when a fracture gap is seen along with displacement of the fragment and volar subluxation of the distal phalanx.

Extension Block Pinning versus percutaneous Fragment Reduction with a Towel Clip and extension Block Pinning with direct Pin Fixation for Treatment of Mallet Fracture

2021 ◽  
Vol 53 (05) ◽  
pp. 447-453
Author(s):  
Jae Hoon Lee ◽  
Duke Whan Chung ◽  
Jong Hun Baek
Keyword(s):  
Clinical Results ◽  
Fracture Fragment ◽  
Percutaneous Reduction ◽  
Mallet Fracture ◽  
Pin Fixation ◽  
Loss Of Reduction ◽  
Before And After ◽  
Group A ◽  
Group B

Abstract Purpose This study compared the clinical and radiographic results between extension block pinning (Group A) and percutaneous reduction of the dorsal fragment with a towel clip followed by extension block pinning with direct pin fixation (Group B) for the treatment of mallet fractures. Patients and Methods A total of 69 patients (group A = 34 patients, group B = 35 patients) who underwent operative treatment for mallet fractures from June 2008 to November 2017 with ≥ 6 months post-surgical follow-up were analysed retrospectively. The extent of subluxation of the distal interphalangeal joint, articular involvement of fracture fragment, fracture gap, and articular step-off were examined on plain radiographs before and after surgery. The functional outcomes were evaluated with the Crawford rating system. Results The postoperative step-offs were 0.16 mm in group A and 0.01 mm in group B. Group B had a significantly better anatomical outcome than group A. Five patients in group A had a loss of reduction. Among them, two had malunion and post-traumatic arthritis. Meanwhile, no patients in group B presented with loss of reduction and nonunion. The mean extension lags were 4.2° in group A and 1.6° in group B. However, functional outcome did not differ between the two groups at the final follow-up. Conclusion Fracture reduction using a towel clip and extension block pinning with direct pin insertion for mallet fracture facilitated the anatomical reduction of fragments, and allowed for stable fixation of fragments. Compared with extension block pinning technique, this technique has shown better anatomical results and stability, but not better clinical results.

scholarly journals Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Distal Humerus ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Humerus Fractures

Abstract Background Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon. Results Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage V were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 min. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

Delayed Single Kirschner Wire Compression Technique for Mallet Fracture

2005 ◽  
Vol 30 (2) ◽  
pp. 180-184 ◽  
Author(s):  
D. FRITZ ◽  
M. LUTZ ◽  
R. ARORA ◽  
M. GABL ◽  
M. WAMBACHER ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Compression Technique ◽  
Active Range Of Motion ◽  
Mallet Fracture ◽  
Strenuous Work ◽  
Distal Interphalangeal ◽  
The Mean

Twenty-four mallet fractures which involved at least one third % of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4–15). At a mean follow-up of 43 (range 12–18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from −2° extension (range 0–10°) to 72° flexion (range 50–90°). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

scholarly journals Proximal humerus fracture–dislocation managed by mini-open reduction and percutaneous screw fixation

2018 ◽  
Vol 11 (5) ◽  
pp. 353-358
Author(s):  
NA Johnson ◽  
R Pandey
Keyword(s):  
Open Reduction ◽  
Proximal Humeral Fracture ◽  
Soft Tissues ◽  
Humeral Fracture ◽  
Fracture Dislocation ◽  
Oxford Shoulder Score ◽  
Fracture Dislocations ◽  
Mini Open ◽  
Shoulder Score

BackgroundWe describe a minimally open reduction and percutaneous fixation technique for three- and four-part proximal humeral fracture–dislocations which preserves soft tissues.MethodsEleven consecutive patients with three-and four-part proximal humeral fracture–dislocations (eight anterior, three posterior dislocations) were treated this way. The dislocation is reduced using a mini-open deltopectoral approach with a horizontal split in subscapularis. Fracture fragments are fixed with percutaneous screws. Constant and Oxford Shoulder Score were collected prospectively.ResultsMean age was 51 years (range 32–65). Mean follow-up was 36 months (range 24–72 months). At last follow-up mean Constant score was 75 (range 64–86) compared to 88 (range 85–92) for the uninjured shoulder. Mean Oxford shoulder score was 41 (range 34–46). One patient developed avascular necrosis. Screw back out was seen in three patients. These were removed under local anaesthesia. There were no screw penetrations of articular surface. One patient suffered a radial nerve neuropraxia which resolved.ConclusionThese results are promising and comparable to published literature with other means of fixation for this complex problem. Due to minimal soft tissue dissection the complications rate is low.

Open reduction and plate fixation of dorsally displaced fractures of the distal radius: surgical technique, clinical and radiological outcome

2009 ◽  
Vol 35 (1) ◽  
pp. 56-60 ◽  
Author(s):  
T. E. J. Hems ◽  
B. Rooney
Keyword(s):  
Distal Radius ◽  
Open Reduction ◽  
Articular Surface ◽  
Plate Fixation ◽  
Young Patients ◽  
Extensor Tendon ◽  
Articular Fractures ◽  
Clinical And Radiological Outcome ◽  
Evaluation Measure

Thirty-five unstable dorsally displaced fractures of the distal radius in 34 patients (mean age 39) were studied; 28 fractures were intra-articular. All fractures had open reduction and fixation, through a dorsal approach, with mini-fragment plates placed between the first and second dorsal tendon compartments and deep to the fourth compartment. A congruous reduction of the articular surface was obtained in all cases. Twenty-four patients were available for follow-up (median 38 months). The Modified Mayo wrist score was excellent in 12 cases, good in four, and fair in eight. The median Patient Evaluation Measure score was 23.5. There were no cases of extensor tendon rupture. Radiographic assessment at follow-up showed a mean palmar angle of 6°. There was evidence of osteoarthritis in six patients who had had intra-articular fractures. Open reduction and plating gives satisfactory medium term results for treatment of displaced intra-articular fractures of the distal radius in young patients.

scholarly journals Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

2020 ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Distal Humerus ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Humerus Fractures

Abstract Background: Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

scholarly journals Treatment of Pediatric Lateral Condylar Humerus Fractures with Closed Reduction and Percutaneous Pinning

2020 ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Fractures In Children ◽  
Humerus Fractures

Abstract Background: Lateral condylar humerus fractures (LCHFs) are the second most common fractures in children. Open reduction and internal fixation is recommended for fractures displaced by more than 4 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction and fixation are necessary to ensure a fracture gap less than 2.0 mm both on anteroposterior view and oblique internal rotational view by fluoroscopy. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

Sign in / Sign up

Export Citation Format

Share Document