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      Quick and safe: why a k-wire-extension-block-fixation of a bony mallet finger is the favoured treatment

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          Abstract

          Introduction

          Mallet fingers are the most common tendon injuries of the hand. Bony avulsion distal finger extensor tendon ruptures causing a mallet finger require special attention and management. In this monocentral study, we analyzed the clinical and individual outcomes succeeding minimal invasive k-wire extension block treatment of bony mallet fingers.

          Materials and methods

          In a retrospective study, we sent a self-designed template and a QUICK-DASH score questionnaire to all patients, who were treated because of a bony mallet finger between 2009 and 2022 and fulfilled the inclusion criteria. A total of 244 requests were sent out. 72 (29.5%) patients participated in the study. Forty-five men and twenty-seven women were included.

          Results

          98.7% ( n = 75) of the cases were successfully treated. Patients were highly satisfied with the treatment (median 8.0; SD ± 2.9; range 1.0–10.0). Based on the QUICK-DASH score, all patients showed no difficulties in daily life. The extent of avulsion did not influence the outcome.

          Conclusion

          We conclude that the minimally invasive treatment of a bony mallet finger should be offered to every patient, because it is safe, fast, and reliable. Thus, we propose to perform extension-block pinning independently of the articular area.

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          Most cited references35

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          The molded polythene splint for mallet finger deformities.

          Since 1970, 151 cases of mallet finger deformities with an average follow-up of 17 months have been treated with a molded polythene splint. Tendon injuries as well as fracture cases are included. This splint has been found to be highly effective, and open reduction of even major fracture fragments without subluxation of the distal phalanx has not been necessary. Although this splint was first described in 1969, detailed results and techniques have not been described previously.
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            Review of Acute Traumatic Closed Mallet Finger Injuries in Adults

            In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.
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              A Systematic Review of Physical Examination Components Adapted for Telemedicine

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                Author and article information

                Contributors
                maximilian.stumpfe@uk-erlangen.de
                Journal
                Arch Orthop Trauma Surg
                Arch Orthop Trauma Surg
                Archives of Orthopaedic and Trauma Surgery
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0936-8051
                1434-3916
                26 December 2023
                26 December 2023
                2024
                : 144
                : 3
                : 1437-1442
                Affiliations
                GRID grid.411668.c, ISNI 0000 0000 9935 6525, Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, , University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, ; Krankenhausstrasse 12, 91054 Erlangen, Germany
                Author information
                http://orcid.org/0000-0003-1338-1060
                Article
                5119
                10.1007/s00402-023-05119-y
                10896929
                38147078
                8c3e45cf-680c-402d-8194-51516550d63a
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 28 November 2022
                : 28 October 2023
                Funding
                Funded by: Universitätsklinikum Erlangen (8546)
                Categories
                Handsurgery
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2024

                Orthopedics
                mallet finger,intervention,kirschner-wire-fixation,bony extensor tendon rupture,mallet fracture

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