Journal List > J Korean Soc Surg Hand > v.18(1) > 1106415

J Korean Soc Surg Hand. 2013 Mar;18(1):1-8. Korean.
Published online March 31, 2013.  https://doi.org/10.12790/jkssh.2013.18.1.1
Copyright © 2013. The Korean Society for Surgery of the Hand
Comparison of Surgical Outcomes of Percutaneous K-Wire Fixation in Bony Mallet Fingers with Use of Towel Clip versus 18-Gauge Needle
Ho-Seung Jeon,1 Chan-Sam Moon,1 Seo-Goo Kang,1 Kyeong-Seop Song,2 and 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, Email: sksub@paran.com
Received October 08, 2012; Revised January 25, 2013; Accepted February 07, 2013.

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

Figures


Fig. 1
A 24-year-old man has a bony mallet finger injury of index finger. (A) The initial anteriorposterior 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.
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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 76 degree on the 3th finger and 0 to 78 degree on the 4th finger.
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Tables


Table 1
Summary of group A cases
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Table 2
Summary of group B cases
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Table 3
Whebe and Schneider's classification
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References
1. Damron TA, Engber WD. Surgical treatment of mallet finger fractures by tension band technique. Clin Orthop Relat Res 1994;(300):133–140.
2. Niechajev IA. Conservative and operative treatment of mallet finger. Plast Reconstr Surg 1985;76:580–585.
3. Bischoff R, Buechler U, De Roche R, Jupiter J. Clinical results of tension band fixation of avulsion fractures of the hand. J Hand Surg Am 1994;19:1019–1026.
4. Choi JY, Jung HJ, Lee HJ, Son KM, Kim YH. Treatment of bony mallet finger: closed reduction using extension block K-wire. J Korean Fract Soc 2004;17:362–367.
5. Wehbe MA, Schneider LH. Mallet fractures. J Bone Joint Surg Am 1984;66:658–669.
6. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg Am 1984;9:231–237.
7. Hahn SH, Yang BK, Yi SR, Chung SW, Oh SJ. Clinical outcome of operative treatment for bony mallet finger. J Korean Soc Surg Hand 2000;5:68–74.
8. Hillman FE. New technique for treatment of mallet fingers and fractures of distal phalanx. J Am Med Assoc 1956;161:1135–1138.
9. Kim SJ, Lee KH, Ha TS. Operative treatment of the mallet finger. J Korean Orthop Assoc 1992;27:796–801.
10. Pratt DR, Bunnell S, Howard LD Jr. Mallet finger; classification and methods of treatment. Am J Surg 1957;93:573–578.
11. Okafor B, Mbubaegbu C, Munshi I, Williams DJ. Mallet deformity of the finger. Five-year follow-up of conservative treatment. J Bone Joint Surg Br 1997;79:544–547.
12. Stern PJ, Kastrup JJ. Complications and prognosis of treatment of mallet finger. J Hand Surg Am 1988;13:329–334.
13. Lubahn JD. Mallet finger fractures: a comparison of open and closed technique. J Hand Surg Am 1989;14:394–396.
14. Stark HH. American Academy of Orthopedic Surgeons. In: Instructional course lectures. Vol 19. St. Louis: Mosby; 1970. Troublesome fractures and dislocations of the hand; pp. 130-149.
15. Takami H, Takahashi S, Ando M. Operative treatment of mallet finger due to intra-articular fracture of the distal phalanx. Arch Orthop Trauma Surg 2000;120:9–13.
16. King HJ, Shin SJ, Kang ES. Complications of operative treatment for mallet fractures of the distal phalanx. J Hand Surg Br 2001;26:28–31.
17. Ishiguro T, Inoue K, Matsubayashi N, Ito Y, Hashizume N. A new method of closed reduction for mallet fractures. Cent Jpn Orthop Traumatol 1988;31:2049–2051.
18. Han CS, Chung DW, Jeong BO, et al. Percutaneous Kirschner wire fixation of acute mallet fractures percutaneousely reduced by towel clip. J Korean Fract Soc 2009;22:283–287.
19. Han KJ, Moon JH, Chung NS, Kang SY. Treatment of mallet fracture of the fingers by percutaneous reduction and pinning. J Korean Soc Surg Hand 2003;8:153–157.