Extension-block pinning to treat bony mallet finger: Is a transfixation pin necessary?

BACKGROUND: Extension-block pinning is a popular treatment for mallet fractures, but it is associated with several pitfalls. Of note, transfixation Kirschner wires used to fix the distal interphalangeal (DIP) joint may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine whether a transfixation pin was necessary for extension-block pinning in the treatment of bony mallet fracture.
METHODS: Patients were treated with a pin-orthosis extension-block technique if they had been diagnosed with a type IVB mallet fracture according to Doyle’s classification. Radiological outcomes were evaluated based on postoperative X-ray results, and functional outcomes were evaluated using Crawford’s criteria.
RESULTS: Thirteen patients (9 males and 4 females) with a mean age of 26 years were included. The mean time between the injury and surgery was 3.3 days, and the mean follow-up period was 8.2 months (range: 4–12 months). Radiographic bone union was achieved in all patients within an average of 5.1 weeks (range: 5–6 weeks). At the final follow-up, the DIP joint had an average degree of flexion of 76.1° (range: 65°–80°) and an average extension deficit of 3.84° (range: 0°–15°). According to Crawford’s criteria, 8 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. No patient reported pain at the final follow-up.
CONCLUSION: Satisfactory clinical and radiological outcomes were obtained with the pin-orthosis extension-block technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.

Kemiksel çekiç parmak tedavisi için ekstansiyon blok pinleme: Transfiksasyon pini gerekli mi?

AMAÇ: Kemiksel çekiç parmak yaralanmalarýnýn tedavisinde popüler bir tedavi yöntemi olan ekstansiyon blok pinleme yönteminde kullanýlan transfiksasyon pininin gerekliliðini araþtýrmak.
GEREÇ VE YÖNTEM: Doyle sýnýflamasýna göre tip 4B çekiç parmak yaralanmasý olan hastalar tariflediðimiz pin-ortez ekstansiyon blok yöntemi ile tedavi edildi. Radyolojik sonuçlar ameliyat sonrasý çekilen röntgenlerle, fonksiyonel sonuçlar Crawford kriterlerine göre deðerlendirildi.
BULGULAR: Yaþ ortalamasý 26 olan 13 hasta (9 erkek, 4 kadýn) çalýþmaya dahil edildi. Yaralanma ile cerrahi arasýnda geçen ortalama süre 3.3 gün, ortalama takip 8.2 ay (daðýlým, 4–12 ay) dý. Tüm hastalarda ortalama 5.1 haftada (daðýlým, 5–6 hafta) radyolojik kemik kaynamasý elde edildi. Son kontrollerde ortalam aktif distal interfalangeal eklem fleksiyonu 76.1° (daðýlým, 65°–80°) ve ortalama ekstansiyon kaybý 3.84° (daðýlým, 0°–15°) di. Crawford kriterlerine göre, sekiz hastada mükemmel sonuç, dört hastada iyi sonuç, bir hastada kötü sonuç elde edildi. Son kontrollerde hiç bir hastada aðrý yoktu.
TARTIÞMA: Kullandýðýmýz pin-ortez ekstansiyon blok tekniðinde tatmin edici klinik ve radyolojik sonuçlar elde ettik. Randomize kontrollü ve ileriye yönelik çalýþmalar ile tekniðin etkinliði teyit edilecektir.