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.

scholarly journals Comparison of Treatment Results for Mallet Finger Fractures in Children Between Low-Intensity Pulsed Ultrasound Stimulation and Ishiguro’s Method

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Tsuyoshi Ota ◽  
Soichiro Itoh ◽  
Yoshihiko Matsuyama
Keyword(s):  
Articular Surface ◽  
Type I ◽  
Mallet Finger ◽  
Pulsed Ultrasound ◽  
Treatment Results ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity ◽  
Fractures In Children ◽  
Mallet Fracture ◽  
Pin Fixation

Background: We compared the treatment results for displaced mallet finger fractures in children between low-intensity pulsed ultrasound (LIPUS) stimulation and Ishiguro’s method, which involves extension block and arthrodesis of the distal interphalangeal (DIP) joint with pinning. Methods: Eleven cases (5 females and 6 males; average age, 13.5 years) of mallet finger were operated with Ishiguro’s method, and 8 cases (3 females and 5 males; average age, 13.0 years) were treated with LIPUS stimulation. Lateral radiographs were used to determine the distance of fragment displacement and the percentage of the articular surface involved in the fragments. Functional outcomes in flexion and extension and those estimated using Crawford’s evaluation criteria at the final visits were assessed in each group. Results: The duration needed for fracture healing was longer, however, active extension and flexion of the DIP joint were significantly larger in the LIPUS group compared with those in the pinning group. Functional recovery was excellent in all cases in the LIPUS group; however, recovery was good in 3 cases and excellent in 8 cases in the pinning group. Extension of the DIP joint was significantly larger when pins were removed in 35 or lesser days postoperatively compared with cases in which pin fixation was continued for more than 35 days. Conclusions: LIPUS therapy may be recommended as an option to treat type I mallet finger in children for whom initiation of treatment was delayed up to 8 weeks. When Ishiguro’s method is applied to the displaced mallet fracture in children, arthrodesis of the DIP joint for more than 5 weeks should be avoided to prevent flexion contracture.

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.

scholarly journals An evaluation of functional outcome following surgical management of fractures of the proximal humerus with Neer’s scoring system

2017 ◽  
Vol 4 (1) ◽  
pp. 46
Author(s):  
Yeshwanth Subash ◽  
Lydia M. ◽  
Kamalakumar K. ◽  
Ilavarasan M. Dhamu
Keyword(s):  
Functional Outcome ◽  
Surgical Management ◽  
Scoring System ◽  
Soft Tissues ◽  
Proximal Humerus ◽  
Articular Surface ◽  
Treatment Options ◽  
Early Mobilization ◽  
Functional Results ◽  
Non Union

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Fractures of the proximal humerus are complex injuries associated with significant morbidity. Various options are available for management including non-operative treatment, depending upon the pattern of the fracture, quality of the bone and the surgeon's familiarity with the techniques. The age of the patient, physical activity and the medical fitness also largely influence the treatment options. The aim of this study was to evaluate the functional outcome following surgical management of these fractures and to compare the results with studies as available in literature</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">30 patients with fractures of the proximal humerus managed by surgical means were studied from January 2012 to January 2014 and were followed up for a minimum period of two years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">All the fractures treated united clinically by 8 weeks and radiologically by 16 weeks. There were no cases of delayed or non-union in our series. The fractures were more common in men with a gender distribution of 1.3:1 and were also more common in the age group of 50 to 65 years (53%). As per the Neer’s scoring system, 60% patients had excellent results while 33% patients had satisfactory results. They were all pain free and successfully returned to their pre-injury work. 6% patients had an unsatisfactory result</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">Surgical management of proximal humerus fractures following the principles of articular surface reconstruction, restoration of the anatomy, stable fixation, with minimal injury to the soft tissues and early mobilization, gives good functional results</span><span lang="EN-IN">.</span></p>

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.

A MODIFIED TENSION BAND WIRING TECHNIQUE FOR TREATMENT OF THE BONY MALLET FINGER

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 235-242 ◽  
Author(s):  
Ryosuke Kakinoki ◽  
Soichi Ohta ◽  
Takashi Noguchi ◽  
Yukitoshi Kaizawa ◽  
Hiromu Itoh ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Surgical Intervention ◽  
Articular Surface ◽  
Steel Wire ◽  
Distal Phalanx ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Stainless Steel Wire ◽  
Mallet Finger ◽  
Fracture Fragment

Purpose: To report the outcomes of mallet fractures treated with our modified tension band wiring technique. Methods: Eleven men and two women (mean age; 33 years) with mallet fractures in which happened more than five weeks before surgery, or with fracture fragments involving more than 2/3 or less than 1/3 of the distal phalanx articular surface or with previous surgical intervention, were subjected to this study. The fracture fragment was fixed with a modified tension band wiring technique using a stainless steel wire and an injection needle. Results: All patients achieved bone union in nine weeks in average. All patients had no pain except one with mild pain. No patient showed a gap or step-off greater than 1 mm. Conclusions: Our tension band wiring technique can be used regardless of the size of the dorsal fracture fragment or the interval between injury and surgery.

scholarly journals Mallet Finger with Facture over 1/3 of the Articular Surface of Distal Phalanx.

1994 ◽  
Vol 43 (1) ◽  
pp. 403-405
Author(s):  
Hidehiro Yanagi ◽  
Katsumi Suzuki ◽  
Kazuo Sakai ◽  
Akinori Sakai ◽  
Kenzou Itou ◽  
...  
Keyword(s):  
Articular Surface ◽  
Distal Phalanx ◽  
Mallet Finger

scholarly journals Infected Non Union of Tibia Managed by Limb Reconstruction System- A Prospective Cohort Study

2020 ◽  
Author(s):  
Narendra Singh Kushwaha ◽  
Mayank Mahendra ◽  
Sanjiv Kumar ◽  
Saurabh Sinha ◽  
Arpit Singh ◽  
...  
Keyword(s):  
Total Duration ◽  
Functional Results ◽  
Continuous Variable ◽  
Fracture Site ◽  
Bony Union ◽  
Complex Situation ◽  
Limb Reconstruction ◽  
Non Union ◽  
Dead Bone ◽  
The Mean

Introduction: Infected non union of Tibia is one of the most commonly faced problem in both compound as well as closed fractures of Tibia, treated surgically. Few patients also present with gap at the fracture site which may be either due to bone loss during trauma or due to debridement of dead bone during previous surgeries. Treatment of infected non union is always challenging with unpredictable outcomes. Limb Reconstruction System (LRS) is one of the systems available to treat this complex situation. Aim: To evaluate the role of LRS in treatment of infected non union of Tibia in terms of union time, total duration of fixator applied and Visual Analouge Score (VAS). Materials and Methods: Twenty one patients of infected gap, non union of tibia were included in the study and were treated with debridement, resection of dead bone and application of LRS and segment transport. The results were evaluated in terms of union time, total duration of fixator applied and VAS. Bony and functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. SPSS statistics 24.0 was used for analysis. Mean, median and mode were used to describe continuous variable. Results: Out of 21 patients, 19 were males and two were females. The mean age of patients was 29.43±14.07 years. The mean limb length discrepancy was 23.3 mm (range, 15-40 mm). The mean duration from injury to LRS application was 7.9 months (range, 6-12 months). Mean duration of follow-up was 29.5 months (range, 16-50 months). Average union time was 44 weeks and average fixator time was 11.2 months. Bony and function results were good and excellent in 90% cases. Conclusion: The use of monolateral rail external fixator LRS is an effective method for the treatment of infected non union of tibia augmented with a fibular strut graft. This provides good results in terms of bony union, subsidence of infection and functional results.

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 Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142097570
Author(s):  
Mossub Qatu ◽  
George Borrelli ◽  
Christopher Traynor ◽  
Joseph Weistroffer ◽  
James Jastifer
Keyword(s):  
Articular Cartilage ◽  
Digital Imaging ◽  
Articular Surface ◽  
Implant Design ◽  
Joint Surface ◽  
Fracture Classification ◽  
Articular Damage ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
The Mean

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

Alternative Conservative Treatment of Mallet-Finger Injuries by Elastic Double-Finger Bandage

1988 ◽  
Vol 13 (2) ◽  
pp. 154-155
Author(s):  
C. HOVGAARD ◽  
B. KLARESKOV
Keyword(s):  
Conservative Treatment ◽  
Skin Irritation ◽  
Prospective Trial ◽  
Mallet Finger ◽  
Finger Injuries

A prospective trial of mallet-finger injuries treated conservatively by elastic double-finger bandage showed no disadvantages compared to other kinds of conservative treatment. The method is agreeable for the patient, being hygienic and causing no kind of skin irritation.

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