Surgical treatment of Mallet finger deformity with Hook plate

고리 금속판을 이용한 망치 손가락의 수술적 치료법

  • Choi, Seok Min (Department of Plastic and Reconstructive Surgery College of Medicine, SoonChunHyang University) ;
  • Jung, Sung Gyun (Department of Plastic and Reconstructive Surgery College of Medicine, SoonChunHyang University) ;
  • Shin, Ho Seong (Department of Plastic and Reconstructive Surgery College of Medicine, SoonChunHyang University) ;
  • Park, Eun Soo (Department of Plastic and Reconstructive Surgery College of Medicine, SoonChunHyang University) ;
  • Kim, Yong Bae (Department of Plastic and Reconstructive Surgery College of Medicine, SoonChunHyang University)
  • 최석민 (순천향대학교 의과대학 성형외과학 교실) ;
  • 정성균 (순천향대학교 의과대학 성형외과학 교실) ;
  • 신호성 (순천향대학교 의과대학 성형외과학 교실) ;
  • 박은수 (순천향대학교 의과대학 성형외과학 교실) ;
  • 김용배 (순천향대학교 의과대학 성형외과학 교실)
  • Published : 2009.05.15

Abstract

Purpose: The bony mallet finger injury is generally managed by conservative treatments, but operative treatments are needed especially when the fractures involve above 30% of articular surface or distal phalanx is accompanied by subluxation in the volar side. This is the reason they often result in chronic instability, articular subluxation and unsatisfactory cosmetic. In this report, We describe new method using the hook plate as an operative treatment of Mallet finger deformity. Methods: Among 13 patients with Mallet finger deformity who came from February 2006 to February 2008, six patient were included in surgical indication. Under local anesthesia, H or Y type incision was made at the DIP joint area. After the DIP joint extension, the hook plate was put on the fracture line, and one self tapping screw was used for fixation. 2 hole plate which was one of the holes in 1.5 mm diameter was cut in almost half and bended through approximately $100^{\circ}$. Results: In all six cases which applied the hook plate, complications such as loss of reduction or nail deformity were not seen. In only one patient, hook pate was removed due to inflammatory reaction after surgery. At 2 weeks after operation, active motion of DIP joint was performed. The result was satisfactory not only cosmetically but also functionally. At 6 weeks after operation, the range of motion of DIP joint was average $64^{\circ}$. Conclusion: The purpose of the operative treatment for mallet finger deformity using the hook plate is to provide anatomical reduction with rigid fixation and to prevent contracture at the DIP joint. While other operations take 6 weeks, the operation using the hook plate begins an active motion at 2 weeks after operation. Complication rate was low and the method is rather simple. Thus, the operation using the hook plate is recommended as a good alternative method of the mallet finger deformity treatment.

Keywords

References

  1. Wehbe MA, Schneider LH: Mallet fractures. J Bone Joint Surg Am 66: 658, 1984 https://doi.org/10.2106/00004623-198466050-00003
  2. Crawford GP: The molded polythene splint for mallet finger deformities. J Hand Surg [Am] 9: 231, 1984 https://doi.org/10.1016/S0363-5023(84)80148-3
  3. Niechajev IA: Conservative and operative treatment of mallet finger. Plast Reconstr Surg 76: 580, 1985 https://doi.org/10.1097/00006534-198510000-00019
  4. Jupiter JB, Sheppard JE: Tension wire fixation of avulsion fractures in the hand. Clin Orthop Relat Res 214: 113, 1987
  5. Inoue G: Closed reduction of mallet fractures using extension-block Kirschner wire. J Orthop Trauma 6: 413, 1992 https://doi.org/10.1097/00005131-199212000-00003
  6. Damron TA, Engber WD: Surgical treatment of mallet finger fractures by tension band technique. Clin Orthop Relat Res 300: 133, 1994
  7. Stern PJ, Kastrup JJ: Complications and prognosis of treatment of mallet finger. J Hand Surg [Am] 13: 329, 1988 https://doi.org/10.1016/S0363-5023(88)80002-9
  8. Lubahn JD: Mallet finger fractures: a comparison of open and closed technique. J Hand Surg Am 14: 394, 1989 https://doi.org/10.1016/0363-5023(89)90121-4
  9. Stark HH, Gainor BJ, Ashworth CR, Zemel NP, Rickard TA: Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits. J Bone Joint Surg Am 69: 892, 1987 https://doi.org/10.2106/00004623-198769060-00015
  10. Hamas RS, Horrell ED, Pierret GP: Treatment of mallet finger due to intra-articular fracture of the distal phalanx. J Bone Surg [Am] 3: 361, 1978
  11. Bischoff R, Buechler U, De Roche R: Clinical results of tension band fixation of avulsion fractures of the hand. J Hand Surg [Am] 19: 1019, 1994 https://doi.org/10.1016/0363-5023(94)90109-0
  12. Damron TA, Engber WD: Surgical treatment of mallet finger fractures by tension band technique. Clin Orthop Relat Res 300: 133, 1994
  13. Kronlage SC, Faust D: Open reduction and screw fixation of mallet fractures. J Hand Surg [Br] 29: 135, 2004 https://doi.org/10.1016/j.jhsb.2003.10.012
  14. Teoh LC, Lee JY: Mallet fractures: a novel approach to internal fixation using a hook plate. J Hand Surg Eur Vol 32: 24, 2007 https://doi.org/10.1016/j.jhsb.2006.09.007
  15. Kang HJ, Shin SJ, Kand ES: Complication of operative treatment for mallet fractures of the distal phalanx. J Hand Surg [Br] 26: 28, 2001 https://doi.org/10.1054/jhsb.2000.0440