scholarly journals Management for Bony Mallet Thumb with a Single Extension Blocking Kirschner Wire

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Sean-Tee J.M Lim ◽  
Muhammad Abrar Qadeer ◽  
Martin Kelly ◽  
Brian Lenehan
Keyword(s):  
Closed Reduction ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Treatment Strategies ◽  
Extensor Tendon ◽  
Conservative And Operative Treatment ◽  
Bone Injury ◽  
Finger Injury ◽  
Mallet Fracture ◽  
Distal Interphalangeal

Introduction: Mallet finger injury is defined by disruption of the terminal extensor tendon distal-to-distal interphalangeal (DIP) joint. While in the fingers, it is a relatively common injury, it is a rarely encountered entity when involving the thumb. Various conservative and operative treatment strategies have been reported for the management of mallet thumb with no consensus by clinicians. Case Report: We present the case of a 27-year-old right hand dominant man with a left bony mallet thumb injury that occurred while playing hurling. Hurling is traditional Irish sport that is one of the fastest field games in the world, involving the use of a wooden Hurley and ball. Clinically, there was loss of active extension at the DIP joint of the non-dominant thumb with radiographs revealing an avulsion fracture involving more than one-third of the articular surface at the base of the distal phalanx. Closed reduction and percutaneous fixation using a single extension block Kirschner wire was performed without a transfixion wire across the DIP joint. Four months postoperatively, the patient had regained that good functional dexterity was able to return to playing hurling. Conclusion: A single K-wire technique may be beneficial with theoretical reduction of chance of iatrogenic nail bed, bone fragment rotation, chondral damage, and bone injury. To the best of our knowledge, no previous reports of its application to bony mallet thumb have been described. Keywords: Mallet fracture, K-wire, hurling, trauma, closed reduction

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 Broken Kirschner Wire in Distal Interphalangeal Joint Fixation: A Case Report

2021 ◽  
Vol 26 (3) ◽  
pp. 171-173
Author(s):  
Kyung Jin Lee ◽  
Jung Hyun Park ◽  
Sung Hoon Koh ◽  
Dong Chul Lee ◽  
Si Young Roh ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Extensor Tendon ◽  
Interphalangeal Joint ◽  
Middle Phalanx ◽  
Distal Interphalangeal Joint ◽  
Protective Measures ◽  
X Ray ◽  
Distal Interphalangeal ◽  
Continued Use

Kirschner wire (K-wire) has been widely used for treatment of fracture for its cost-effectiveness and reliability. This case presents the K-wire breakage in distal interphalangeal joint (DIPJ) fixation. A 55-year-old male patient was injured by a knife and showed rupture of extensor tendon at 1/2 of middle phalanx. A 0.9-mm K-wire was implemented for DIPJ extension, and tenorrhaphy was done. After 6 weeks, we detected breakage of K-wire in the follow-up X-ray. The broken K-wire in the distal phalanx was removed. We removed the remaining K-wire through an incision on volar side of middle phalanx under C-arm after 2 weeks for the patient’s personal reasons. Breakage during postoperative K-wire maintenance is exceedingly rare. This patient is presumed to have ruptured because he continued using his finger. Therefore, while K-wire is present, continued use of finger without protection may cause breakage, so protective measures such as splint are required.

scholarly journals Two Extension Block Kirschner Wires’ Technique for Bony Mallet Thumb

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Yutaka Mifune ◽  
Atsuyuki Inui ◽  
Fumiaki Takase ◽  
Yasuhiro Ueda ◽  
Issei Shinohara ◽  
...  
Keyword(s):  
Avulsion Fracture ◽  
Articular Surface ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Distal Phalanx ◽  
Extensor Mechanism ◽  
Kirschner Wires ◽  
Fracture Fragment ◽  
Conservative And Operative Treatment ◽  
Digital Block

Mallet fingers with an avulsion fracture of the distal phalanx or rupture of the terminal tendon of the extensor mechanism is known as a common injury, while mallet thumb is very rare. In this paper, the case of a 19-year-old woman with a sprained left thumb sustained while playing basketball is presented. Plain radiographs and computed tomography revealed an avulsion fracture involving more than half of the articular surface at the base of the distal phalanx. Closed reduction and percutaneous fixation were performed using the two extension block Kirschner wires’ technique under digital block anesthesia. At 4 months postoperatively, the patient had achieved excellent results according to Crawford’s evaluation criteria and had no difficulties in working or playing basketball. Various conservative and operative treatment strategies have been reported for management of mallet thumb. We chose the two extension block Kirschner wires’ technique to minimize invasion of the extensor mechanism and nail bed and to stabilize the large fracture fragment.

REVIEW ON MALLET FINGER TREATMENT

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 439-447 ◽  
Author(s):  
Jason Pui Yin Cheung ◽  
Boris Fung ◽  
Wing Yuk Ip
Keyword(s):  
Avulsion Fracture ◽  
Articular Surface ◽  
Extensor Tendon ◽  
Distal Phalanx ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Dorsal Aspect ◽  
Surgical Fixation ◽  
Distal Interphalangeal ◽  
Open Injuries

Mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of the terminal extensor tendon. It is usually caused by a forceful blow to the tip of the finger causing sudden flexion or a hyperextension injury. Fracture at the dorsal aspect of the base of the distal phalanx is commonly associated with palmar subluxation of the distal phalanx. Most mallet finger injuries are recommended to be treated with immobilisation of the distal interphalangeal joint in extension by splints. There is no consensus on the type of splint and the duration of use. Most studies have shown comparable results with different splints. Surgical fixation is still indicated in certain conditions such as open injuries, avulsion fracture involving at least one third of the articular surface with or without palmar subluxation of the distal phalanx and also failed splinting treatment.

The Treatment of Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint by Closed Reduction and Kirschner Wire Fixation: A 16-Year Follow Up

2001 ◽  
Vol 26 (6) ◽  
pp. 537-540 ◽  
Author(s):  
D. P. NEWINGTON ◽  
T. R. C. DAVIS ◽  
N. J. BARTON
Keyword(s):  
Closed Reduction ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Long Term Results ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Ten patients who had sustained 11 unstable dorsal fracture-dislocations of finger proximal interphalangeal joints were reviewed at a mean follow-up of 16 years. All had been treated acutely by closed reduction and transarticular Kirschner wire fixation of the proximal interphalangeal joint, without any attempt at reduction of the fracture of the base of the middle phalanx, which probably involved 30–60% of the articular surface. Seven of the ten patients complained of no finger pain or stiffness, and none complained of severe pain. There was a mean fixed flexion deformity of 81 at the proximal interphalangeal joint, which had a mean arc of movement of 851. Although subchondral sclerosis and mild joint space narrowing were observed in some instances, there were no severe degenerative changes. These results confirm that this technique is a reliable treatment method for these injuries, and produces satisfactory long-term results.

scholarly journals Causes of Procedural Failures of Closed Reductions using an Extension-Block Pin for Bony Mallet Finger

2020 ◽  
Author(s):  
Taku Suzuki ◽  
Takuji Iwamoto ◽  
Noboru Matsumura ◽  
Hiroo Kimura ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Medical Records ◽  
Closed Reduction ◽  
Kirschner Wire ◽  
Interphalangeal Joint ◽  
Bone Union ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Reduction Procedure ◽  
Before And After ◽  
Distal Interphalangeal

AbstractThis retrospective study evaluated procedural failures of closed reductions using an extension-block Kirschner wire (K-wire) for bony mallet finger. A total of 132 patients who underwent a closed reduction for bony mallet finger in a procedure using an extension-block K-wire were radiographically assessed. Radiographs were used to evaluate (1) postoperative displacement of the reduction before or after K-wire removal and (2) inaccurate reduction of the fragment immediately after surgery. The causes of procedural failure and bone union were evaluated using radiographs and medical records of the intraoperative findings. Out of 132 patients, 17 with procedural failure were enrolled. Displacement of the reduction before and after K-wire removal occurred in seven and six cases, respectively. Inaccurate reduction immediately after surgery occurred in four cases. The most common cause of procedural failure was inaccurate insertion of the K-wire to fix the distal interphalangeal joint (eight cases) followed by inaccurate insertion of the extension-block pin (five cases). All patients had bone union regardless of the displacement of the reduction or inaccurate reduction of the fragment. Caution should be exercised during the reduction and fixation when an extension-block K-wire is used in a closed reduction procedure.

The risk factors associated with subluxation of the distal interphalangeal joint in mallet fracture

2014 ◽  
Vol 40 (1) ◽  
pp. 63-67 ◽  
Author(s):  
J. K. Kim ◽  
D. J. Kim
Keyword(s):  
Risk Factors ◽  
Articular Surface ◽  
Multiple Logistic Regression Analysis ◽  
Distal Phalanx ◽  
Receiver Operating Curve ◽  
Level Of Evidence ◽  
Mallet Fracture ◽  
Significant Difference ◽  
Distal Interphalangeal ◽  
Fracture Size

Surgical fixation is recommended when a mallet fracture involves more than one-third of the articular surface of the distal phalanx. This recommendation originates from the idea that involvement of more than one-third of the base of the distal phalanx causes subluxation of the distal interphalangeal (DIP) joint. Eighty-six fingers of 85 patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx were enrolled in this study. Patients were allocated on the basis of subluxation of the DIP joint into a group with no subluxation or a group with subluxation. These two groups were compared with respect to age, sex, fracture size, fracture displacement, time to finger immobilizer application, and initial extensor lag of the DIP joint. Backward stepwise multiple logistic regression analysis was performed to identify the risk factors of DIP joint subluxation, and receiver operating curve analysis was used to calculate the optimal cut-off point for the risk factors. Half of our patients with a mallet fracture involving > one-third of the articular surface of the distal phalanx showed subluxation of the DIP joint. A significant intergroup difference was found for fracture size and time to application of a finger immobilizer, but no significant difference was observed for other parameters. The risk factors of DIP joint subluxation were fracture size and time to application of finger immobilizer. The optimal cut-off values for the development of DIP joint subluxation were 48% for the fracture size and 12.5 days for time to finger immobilizer application. Level of Evidence: Prognosis, II

scholarly journals The Diagnosis and Management of Mallet Finger Injuries

Hand ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Gregory A. Lamaris ◽  
Michael K. Matthew
Keyword(s):  
Surgical Intervention ◽  
Articular Surface ◽  
Extensor Tendon ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Finger Injuries ◽  
Diagnosis And Management ◽  
Distal Interphalangeal ◽  
Tendon Insertion ◽  
Almost All

Background: Mallet finger is a common injury of the extensor tendon insertion causing an extension lag of the distal interphalangeal joint. Methods: We reviewed the most current literature on the epidemiology, diagnosis, and management of mallet finger injuries focusing on the indications and outcomes of surgical intervention. Results: Nonoperative management has been advocated for almost all mallet finger injuries; however, complex injuries are usually treated surgically. There is still controversy regarding the absolute indications for surgical intervention. Conclusions: Although surgery is generally indicated in the case of mallet fractures involving more than one-third of the articular surface as well as in all patients who develop volar subluxation of the distal phalanx, a significant advantage of surgical management even in those complicated cases has yet to be clearly proven.

scholarly journals Closed Reduction and Percutaneous Kirschner Wire Fixation Combined with Plaster Cast versus Conventional Plaster Cast immobilization in the Treatment of Colles' Fracture – A Prospective Randomized Comparative Study

1970 ◽  
Vol 17 (2) ◽  
pp. 98-105 ◽  
Author(s):  
KS Uzzaman ◽  
KA Awal ◽  
MK Alam
Keyword(s):  
Comparative Study ◽  
Closed Reduction ◽  
Kirschner Wire ◽  
Plaster Cast ◽  
Cast Immobilization ◽  
Fixation Group ◽  
Wire Fixation ◽  
Colles Fracture ◽  
End Results

Purpo'e: To evaluate functional & anatomical results of the Colles’ fracture treated by two methods- i) Closed reduction & precutaneous kirschner wire (K- wire) fixation combined with plaster cast & ii) Conventional plaster cast immobilization after closed reduction.Methods: A randomized prospective comparative study was done from July 2003 to June 2005 on 52 patient with Colles' fracture in NITOR, Dhaka. 12 patients lost from follow up. Twenty patient (20) in each group were finally available for evaluation. The group treated by closed reduction & percutaneous K-wire fixation combined with plaster cast- designated as "Arm A" & another group treated conventionally by plaster cast only designated by "Arm-B". Male Female ratio was 1:3, Age range was 35 to 70 years (Mean age 52.5 years) Distribution of limbs side involvement almost equal. Mode of injuries were domestic fall & RTA (4:1) According to AO classification fracture were in both groups- A2 = 13, A3 = 10, C1 = 6, C2 = 8 & C3 = 3 (Total- 40). Follow up period was 6-14 months (mean = 6 month)Results: Union time for most of the fractures was 6-8 weeks. At final follow up Satisfactory Anatomical end results of percutuneous fixation group (Arm-A) were 80% and in conventional plaster cast group (Arm-B) were 35%. (P<0.01). Satisfactory functional end results in Arm-A group were 70% and in Arm-B group were 30% (P<0.01) Complications seen much more in conventional group (Arm-B) than percutaneous K-wire fixation group (Arm-B). Sarmiento & Latta’s criteria was used to evaluate the progress.Conclusion: The coventional plaster cast method for treatment of colles’ fracture usually can't maintain radial length & angulation in many instances and results significant anatomical difficultly and functional disability. On the other hand after close reduction additional fixation in the form of percutaneous crossed K-wire can maintain the reduction till bony union & prevent late collapse at fracture site & provides better result. Key Words: Colles' fracture; closed reduction; Plaster cast & Kirschner wire (K-wire) fixationDOI: 10.3329/jdmc.v17i2.6591J Dhaka Med Coll. 2008; 17(2) : 98-105

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