Surgical treatment of the bony mallet thumb: a case series and literature review

Introduction The aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method. Patients and methods All patients (n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb (n = 21 articles). Results Surgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. An open reduction led to worse functional scores compared to a closed reduction. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods. Conclusion The evidence for the best treatment of a bony mallet thumb fracture is low. On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.

The AMIGAS Model: Reconciling Prejudice Reduction and Collective Action Approaches Through a Multicultural Commitment in Intergroup Relations

Social psychology’s search for ways to address intergroup inequality has grappled with two approaches that have been considered incompatible: (a) the prejudice reduction approach, that argues that changing individual negative attitudes will undermine the basis for discrimination and lead to intergroup harmony; and (b) the collective action approach, that argues that social protest and activism can improve the position of disadvantaged groups. The problem is that efforts toward prejudice reduction may serve to suppress genuine efforts to change. We propose the Achieving Multicultural Integration of Groups Across Society (AMIGAS) model, in which a multicultural commitment is proposed as a driver of both improved intergroup evaluations and promotion of collective action for reduced inequality, especially in contexts where there are conditions for a respectful intercultural dialogue. The AMIGAS model is a theoretical advance in the field of intergroup relations and a basis for implementing effective egalitarian policies and practices.