What are surgical techniques used for treatment of mallet finger?

Updated: Aug 27, 2018
  • Author: Roy A Meals, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

Many surgeons prefer operative treatment of mallet injuries that are accompanied by volar subluxation of the distal phalanx. The belief is that the restoration of joint alignment and the balance between flexor and extensor forces is needed to obtain an adequate functional result in these patients. In general, the joint is reduced, and a transarticular Kirschner wire (K-wire) is placed. If the fracture fragment cannot be held in reasonably close approximation to its insertion site, it may be stabilized with another K-wire or with the pull-out suture technique. [13, 14, 15, 16, 17, 18, 11, 19, 9]

Occasionally, certain patients (eg, surgeons or dentists) may be unable to wear splints for the required 6-8 weeks for vocational reasons. With a digital block, a 0.035-in. K-wire can be inserted across the joint to serve as a temporary internal splint. Although the wire may help to maintain the reduction of a bony fragment, its primary purpose is to maintain extension of the joint. It can be difficult to get a K-wire to engage in the distal phalangeal tuft for a retrograde pinning.

Another option is to insert an oblique, antegrade K-wire by starting at the midportion of the middle phalanx and placing the K-wire obliquely into the main body of the distal phalanx. By starting on the ulnar side of the digit, the wire can be clipped off just below the surface of the skin. The K-wire stabilization should be protected with an external splint when patients are not engaged in critical portions of their occupation. The K-wire can be retrieved and extracted with local anesthesia at the end of treatment.

On the basis of results in 9 patients with mallet fracture in whom extension block pinning had failed, Lee et al concluded that tension wire fixation can be an effective second-line treatment in such cases. [20]

A study by Wang et al indicated that when splinting fails to achieve adequate resolution of tendinous mallet finger, a tendon-bone graft can be an effective alternative treatment. In 28 patients for whom splinting had failed, grafts were taken from the extensor carpi radialis brevis and the third metacarpal base. [21]


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