Treatment of Wehbe-Schneider types<b>Ⅰ</b>B and <b>Ⅱ</b>B bony mallet fingers with one-stage closed reduction and elastic compression fixation with double Kirschner wires_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Weifeng ^1,2,3 , ZHANG Jingbiao ¹ , AN Qing ¹ , ZHENG Zhiyuan ¹ ,  GUAN Jianzhong ^2,3

1. The First Department of Orthopedics, the People’s Hospital of Lixin County, Bozhou Anhui, 236700, P. R. China;
2. Department of Orthopedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233004, P. R. China;
3. Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233030, P. R. China;

Corresponding author：

GUAN Jianzhong, Email: guanjianzhong@bbmc.edu.cn

Keywords：

Bony mallet finger; avulsion fracture; closed reduction; Kirschner wire; internal fixation

DOI：

10.7507/1002-1892.202112088

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Objective To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers. Methods Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with one-stage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years (range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in 7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours (mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint (DIPJ) was (40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at 6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started. Results The operation time was 35-55 minutes (mean, 43.9 minutes). The length of hospital stay was 2-5 days (mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months (mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks (mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale (VAS) score of pain during active flexion of the DIPJ was 1-3 (mean, 1.6); the VAS score of pain was 2-5 (mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was (2.14±2.54)°, showing significant difference when compared with preoperative angle (t=52.186, P<0.001). There was no significant difference in the active flexion angle between the affected finger (79.52±6.31)° and the corresponding healthy finger (81.90±5.36)° (t=1.319, P=0.195). At 6 months after operation, according to Crawford functional evaluation criteria, the effectiveness was rated as excellent in 11 cases, good in 9, and fair in 1, with an excellent and good rate of 95.24%. Conclusion For Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers, one-stage closed reduction and elastic compression fixation with double Kirschner wires can effectively correct the deformity and has the advantages of simple surgery, no incision, and no influence on the appearance of the affected finger.

Citation： LI Weifeng, ZHANG Jingbiao, AN Qing, ZHENG Zhiyuan, GUAN Jianzhong. Treatment of Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers with one-stage closed reduction and elastic compression fixation with double Kirschner wires. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 400-404. doi: 10.7507/1002-1892.202112088 Copy

1.	Cavanaugh PK, Watkins C, Jones C, et al. Effectiveness of quickcast versus custom-fabricated thermoplastic orthosis immobilization for the treatment of mallet fingers: A randomized clinical trial. Hand (N Y), 2021. doi: 10.1177/1558944720988136.
2.	Kootstra TJM, Keizer J, van Heijl M, et al. Delayed extension block pinning in 27 patients with mallet fracture. Hand (N Y), 2021, 16(1): 61-66.
3.	李海洋, 桑庆华, 张利辉. 改良石黑法治疗骨性锤状指的疗效观察. 中国骨与关节损伤杂志, 2020, 35(1): 101-102.
4.	薛云皓, 田光磊. 172例闭合性锤状指畸形的统计学分析. 中华手外科杂志, 2014, 30(2): 94-97.
5.	Ozturk T, Erpala F, Zengin EC, et al. Comparison of interfragmentary pinning versus the extension block technique for acute Doyle type 4c mallet finger. Hand Surg Rehabil, 2022, 41(1): 131-136.
6.	Wehbe MA, Schneider LH. Mallet fractures. J Bone Joint Surg (Am), 1984, 66(5): 658-669.
7.	Wang WC, Hsu CE, Yeh CW, et al. Functional outcomes and complications of hook plate for bony mallet finger: a retrospective case series study. BMC Musculoskelet Disord, 2021, 22(1): 281. doi: 10.1186/s12891-021-04163-2.
8.	王波, 胡春晓, 胡春良, 等. 不经关节面的双克氏针法治疗骨性锤状指. 实用骨科杂志, 2020, 26(7): 641-643.
9.	Kim JY, Lee SH. Factors related to distal interphalangeal joint extension loss after extension block pinning of mallet finger fractures. J Hand Surg (Am), 2016, 41(3): 414-419.
10.	Anderson D. Mallet finger-management and patient compliance. Aust Fam Physician, 2011, 40(1-2): 47-48.
11.	Orman O, Baydar M, İpteç M, et al. A new custom-made plate preparation method for bony mallet finger treatment and a comparison with extension block technique. Jt Dis Relat Surg, 2021, 32(3): 617-624.
12.	Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg (Am), 1984, 9(2): 231-237.
13.	赵文韬, 赵民. 手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究. 中国临床解剖学杂志, 2021, 39(2): 126-129.
14.	Gumussuyu G, Asoglu MM, Guler O, et al. Extension pin block technique versus extension orthosis for acute bony mallet finger; a retrospective comparison. Orthop Traumatol Surg Res, 2021, 107(5): 102764. doi: 10.1016/j.otsr.2020.102764.
15.	Neuhaus V, Thomas MA, Mudgal CS. Type Ⅱb bony mallet finger: is anatomical reduction of the fracture necessary? Am J Orthop (Belle Mead NJ), 2013, 42(5): 223-226.
16.	Chen Q, Suo Y, Pan D, et al. Elastic fixation of mallet finger fractures using two K-wires: A case report of a new fixation technique. Medicine (Baltimore), 2019, 98(20): e15481. doi: 10.1097/MD.0000000000015481.
17.	Lee SK, Kim YH, Moon KH, et al. Correlation between extension-block K-wire insertion angle and postoperative extension loss in mallet finger fracture. Orthop Traumatol Surg Res, 2018, 104(1): 127-132.
18.	Garg BK, Rajput SS, Purushottam GI, et al. Delta wiring technique to treat bony mallet finger: No need of transfixation pin. Tech Hand Up Extrem Surg, 2020, 24(3): 131-134.
19.	Suzuki T, Iwamoto T, Matsumura N, et al. Causes of procedural failures of closed reductions using an extension-block pin for bony mallet finger. J Hand Microsurg, 2021, 13(2): 69-74.
20.	Karslioğlu B, Uzun M, Tetik C, et al. Derotation of the mallet piece: A crucial point in mallet fracture surgery. Hand Surg Rehabil, 2018, 37(4): 202-205.

1. Cavanaugh PK, Watkins C, Jones C, et al. Effectiveness of quickcast versus custom-fabricated thermoplastic orthosis immobilization for the treatment of mallet fingers: A randomized clinical trial. Hand (N Y), 2021. doi: 10.1177/1558944720988136.
2. Kootstra TJM, Keizer J, van Heijl M, et al. Delayed extension block pinning in 27 patients with mallet fracture. Hand (N Y), 2021, 16(1): 61-66.
3. 李海洋, 桑庆华, 张利辉. 改良石黑法治疗骨性锤状指的疗效观察. 中国骨与关节损伤杂志, 2020, 35(1): 101-102.
4. 薛云皓, 田光磊. 172例闭合性锤状指畸形的统计学分析. 中华手外科杂志, 2014, 30(2): 94-97.
5. Ozturk T, Erpala F, Zengin EC, et al. Comparison of interfragmentary pinning versus the extension block technique for acute Doyle type 4c mallet finger. Hand Surg Rehabil, 2022, 41(1): 131-136.
6. Wehbe MA, Schneider LH. Mallet fractures. J Bone Joint Surg (Am), 1984, 66(5): 658-669.
7. Wang WC, Hsu CE, Yeh CW, et al. Functional outcomes and complications of hook plate for bony mallet finger: a retrospective case series study. BMC Musculoskelet Disord, 2021, 22(1): 281. doi: 10.1186/s12891-021-04163-2.
8. 王波, 胡春晓, 胡春良, 等. 不经关节面的双克氏针法治疗骨性锤状指. 实用骨科杂志, 2020, 26(7): 641-643.
9. Kim JY, Lee SH. Factors related to distal interphalangeal joint extension loss after extension block pinning of mallet finger fractures. J Hand Surg (Am), 2016, 41(3): 414-419.
10. Anderson D. Mallet finger-management and patient compliance. Aust Fam Physician, 2011, 40(1-2): 47-48.
11. Orman O, Baydar M, İpteç M, et al. A new custom-made plate preparation method for bony mallet finger treatment and a comparison with extension block technique. Jt Dis Relat Surg, 2021, 32(3): 617-624.
12. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg (Am), 1984, 9(2): 231-237.
13. 赵文韬, 赵民. 手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究. 中国临床解剖学杂志, 2021, 39(2): 126-129.
14. Gumussuyu G, Asoglu MM, Guler O, et al. Extension pin block technique versus extension orthosis for acute bony mallet finger; a retrospective comparison. Orthop Traumatol Surg Res, 2021, 107(5): 102764. doi: 10.1016/j.otsr.2020.102764.
15. Neuhaus V, Thomas MA, Mudgal CS. Type Ⅱb bony mallet finger: is anatomical reduction of the fracture necessary? Am J Orthop (Belle Mead NJ), 2013, 42(5): 223-226.
16. Chen Q, Suo Y, Pan D, et al. Elastic fixation of mallet finger fractures using two K-wires: A case report of a new fixation technique. Medicine (Baltimore), 2019, 98(20): e15481. doi: 10.1097/MD.0000000000015481.
17. Lee SK, Kim YH, Moon KH, et al. Correlation between extension-block K-wire insertion angle and postoperative extension loss in mallet finger fracture. Orthop Traumatol Surg Res, 2018, 104(1): 127-132.
18. Garg BK, Rajput SS, Purushottam GI, et al. Delta wiring technique to treat bony mallet finger: No need of transfixation pin. Tech Hand Up Extrem Surg, 2020, 24(3): 131-134.
19. Suzuki T, Iwamoto T, Matsumura N, et al. Causes of procedural failures of closed reductions using an extension-block pin for bony mallet finger. J Hand Microsurg, 2021, 13(2): 69-74.
20. Karslioğlu B, Uzun M, Tetik C, et al. Derotation of the mallet piece: A crucial point in mallet fracture surgery. Hand Surg Rehabil, 2018, 37(4): 202-205.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers with one-stage closed reduction and elastic compression fixation with double Kirschner wires

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