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Jeon, Moon, Kang, Song, and Choi: Comparison of Surgical Outcomes of Percutaneous K-Wire Fixation in Bony Mallet Fingers with Use of Towel Clip versus 18-Gauge Needle
Original Article

J Korean Soc Surg Hand 2013;18(1):1-8.

Published online: 12 March 2013

DOI: https://doi.org/10.12790/jkssh.2013.18.1.1

Comparison of Surgical Outcomes of Percutaneous K-Wire Fixation in Bony Mallet Fingers with Use of Towel Clip versus 18-Gauge Needle

Ho-Seung Jeon1, Chan-Sam Moon1, Seo-Goo Kang1, Kyeong-Seop Song2, Uk-Hyun Choi2

1Department of Orthopedic Surgery, Sung-Ae Hospital, Seoul, Korea

2Department of Orthopaedic Surgery, Kwangmyung Sung-Ae Hospital, Gwangmyeong, Korea

Correspondence to: Kyeong-Seop Song Department of Orthopedic Surgery, Kwangmyung Sung-Ae Hospital, 36 Digital-ro, Gwangmyeong 423-711, Korea TEL: +82-2-2680-7263 FAX: +82-2-2617-9039 E-mail: sksub@paran.com

Received 8 October 201225 January 2013       Accepted 7 February 2013

Copyright © 2013 The Korean Society for Surgery of the Hand

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose was to describe comparative analysis of the surgical outcome of percutaneous K-wire fixation of bony mallet fingers reduced with towel clip and 18-gauge needle.

Methods:

We analyzed the bony mallet finger patients with more than twelve months follow-up after percutaneous K-wire fixation. The patients were randomly divided into two groups. Eighteen fingers were treated with closed reduction using towel clip and 18 other fingers were treated with closed reduction using 18-gauge needle.

Results:

Radiographs showed bony union and no subluxation in all cases after K-wire removal. The average extension lag was 2.8°/1.9°, and range of motion of distal interphalangeal joint was 70.3°/75° respectively. According to Crawford's criteria, excellent results were obtained in 9/11 fingers, good results in 8/7 fingers, and poor result in 1/0 finger, respectively.

Conclusion:

18-gauge needle reduction in percutaneous K-wire fixation is considered less invasive and useful method for treatment of bony mallet finger with comparable results with towel clip reduction.

Keywords: Bony mallet finger, K-wire, Towel clip, 18-Gauge needle

REFERENCES

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Fig. 1.
A 24-year-old man has a bony mallet finger injury of index finger. (A) The initial anterioposterior and lateral X-ray show displaced dorsal fragment and articular involvement more than 30% without subluxation. (B) Percutaneous pinning with towel clip reduction is performed. (C) At postopertive 12 months, the fracture is united and the patient has a range of motion from 0 to 75 degree.
jkssh-18-1f1.tif
Fig. 2.
A 36-year-old man has a bony mallet finger injury of the 4, 5th finger. (A) The initial anteriorposterior and lateral X-ray show a displaced dorsal fragment and articular involvement more than 30% without subluxation. (B) Percutaneous pinning with towel clip reduction is performed. (C) At postoperative 12 months, the fracture is united and the patient has a range of motion from 5 to 78 degree on the 3th finger and 0 to 78 degree on the 4th finger.
jkssh-18-1f2.tif
Table 1.
Summary of group A cases
No Sex Age (yr) D Cause Class TO (day) R (°) E (°) F/U (mo) Results
1 F 40 D Fight IIB 7 74 0 15 Excellent
2 M 38 D Fall IB 2 71 0 14 Excellent
3 F 24 ND Sports IB 4 78 0 12 Excellent
4 M 14 D Sports IIB 1 70 5 15 Good
5 F 32 ND Fight IIB 5 69 0 12 Excellent
0 F 28 D TA IB 7 72 0 15 Excellent
7 M 47 D Sports IIB 1 74 0 12 Excellent
8 M 34 D TA IIB 3 68 5 15 Good
9 F 68 ND Sports IIB 7 68 5 13 Good
10 M 25 D Sports IB 7 74 0 12 Excellent
11 M 25 D Sports IB 7 64 5 12 Good
12 M 47 ND Fight IIB 7 74 0 12 Excellent
13 F 43 D Sports IIB 3 66 4 12 Good
14 M 21 D Sports IIC 4 64 12 15 Fair
15 M 24 D Fight IB 3 68 5 12 Good
16 M 49 ND Fight IIB 8 71 0 12 Excellent
17 F 33 D Sports IIB 2 71 4 12 Good
18 M 29 D TA IIB 5 69 5 15 Good

D: dominant hand, Class: Wehbe and Schneider's classification, TO: duration between trauma day and operation day, R: range of motion, E: extension lag, F/U: follow-up duration, Results: according to Crawford's criteria, ND: non-dominant hand, TA: traffic accident.

Table 2.
Summary of group B cases
No Sex Age (yr) D Cause Class TO (day) R (°) E (°) F/U (mo) Results
1 M 50 ND Sports IB 5 78 0 12 Excellent
2 F 36 D Fall IIB 4 70 4 15 Good
3 F 14 ND Sports IB 1 73 0 12 Excellent
4 M 24 D Sports IIB 7 75 0 15 Excellent
5 M 22 D Fight IIB 3 73 0 12 Excellent
6 F 18 D TA IIB 3 74 0 12 Excellent
7 M 37 ND Sports IIB 1 70 0 12 Excellent
8 F 34 D Fall IIC 5 76 3 15 Good
9 F 58 ND Sports IIB 21 77 4 12 Good
10 M 65 D TA IIB 13 78 0 12 Excellent
11 M 54 D Sports IIC 10 76 5 15 Good
12 M 47 ND Fight IIB 7 75 0 12 Excellent
13 F 43 D Sports IIB 3 76 0 12 Excellent
14 M 36 D Sports IC 4 78 0 15 Excellent
15 M 36 D Sports IB 4 76 5 12 Good
16 M 49 ND Fight IIB 6 76 0 12 Excellent
17 F 33 D Sports IIB 2 75 4 12 Good
18 M 29 D TA IIB 5 73 5 15 Good

D: dominant hand, Class: Wehbe and Schneider's classification, TO: duration between trauma day and operation day, R: range of motion, E: extension lag, F/U: follow-up duration, Results: according to Crawford's criteria, ND: non-dominant hand, TA: traffic accident.

Table 3.
Whebe and Schneider's classification
Type
  I. Fracture include bone injuries of varying extent without suluxation of the distal interphalangeal joint
  II. Fracture are associated with subluxation of the distal interphalangeal joint
  III. Epiphyseal and physeal injury
Subtypes
  A. Fracture fragment involving less than one third of the articular surface of the distal phalanx
  B. Fracture fragment involving one third to two thirds of the articular surface
  C. Fracture fragment involving more than two thirds of the articular surface
Table 4.
Outcome assessment (Crawford, 1984)
Excellent Full flexion Full extension No pain
Good Full flexion Loss of extension 0° and 10° No pain
Fair Any loss of flexion Loss of extension 10° and 25° No pain
Poor Any loss of flexion Loss of extension >25° Persistent pain
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