The Outcomes of Extension Block Pinning and Nonsurgical Management for Mallet Fracture

Jun O Yoon; Hyungki Baek; Jae Kwang Kim

doi:10.1016/j.jhsa.2017.02.003

The Outcomes of Extension Block Pinning and Nonsurgical Management for Mallet Fracture

J Hand Surg Am. 2017 May;42(5):387.e1-387.e7. doi: 10.1016/j.jhsa.2017.02.003. Epub 2017 Mar 6.

Authors

Jun O Yoon¹, Hyungki Baek², Jae Kwang Kim³

Affiliations

¹ Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
² Department of Orthopedic Surgery, Ewha Womans Universtiy Mokdong Hospital, Seoul, Republic of Korea.
³ Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: orth4535@gmail.com.

PMID: 28274605
DOI: 10.1016/j.jhsa.2017.02.003

Abstract

Purpose: We aimed to compare the clinical and radiographic results of patients with a mallet fracture involving more than one-third of the articular surface, but without a high degree of distal interphalangeal (DIP) joint subluxation, treated with extension block pinning or nonsurgical management.

Methods: Forty-nine patients with a mallet fracture involving more than one-third of the articular surface were reviewed. Twenty-six cases were treated using extension block pinning (surgery group) and 23 were treated nonsurgically (nonsurgical group). At the final follow-up, extension lag and flexion of the DIP joint of the affected digit were measured. Distal interphalangeal joint pain was rated using a visual analog scale and the overall clinical outcomes were graded using Crawford's criteria. Complications, including nail deformity and dorsal prominence, were also assessed. The rate of DIP joint subluxation and fracture fragment size were radiographically evaluated.

Results: Mean extension lag and flexion of the DIP joint and mean visual analog pain scores were not significantly different in the 2 groups. Outcomes, as assessed using Crawford's criteria, were excellent in 5, good in 12, fair in 6, and poor in 3 in the surgery group, and excellent in 2, good in 11, fair in 8, and poor in 2 in the nonsurgical group. Moreover, the frequency of nail deformity or dorsal prominence was similar in the 2 groups. The rate of DIP subluxation and mean fracture fragment size were similar between the 2 groups. All the fractures had united by 3 months after injury in both groups.

Conclusions: The clinical outcomes do not significantly differ between extension block pinning and nonsurgical management for mallet fractures involving more than one-third of the articular surface, but without high degree subluxation of the DIP joint.

Type of study/level of evidence: Therapeutic IV.

Keywords: Mallet fracture; conservative treatment; extension block pinning.

Publication types

Comparative Study

MeSH terms

Adolescent
Adult
Aged
Bone Nails*
Female
Finger Phalanges / injuries*
Fracture Fixation, Internal*
Humans
Intra-Articular Fractures / diagnostic imaging
Intra-Articular Fractures / therapy*
Male
Middle Aged
Orthotic Devices*
Radiography
Range of Motion, Articular
Retrospective Studies
Treatment Outcome
Young Adult