Mallet fractures: a novel approach to internal fixation using a hook plate

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Traumatology

Background:

• Mallet fractures of the distal phalanx are common hand injuries.
• Traditional fixation methods can be challenging due to small avulsion fragments.
• Prolonged splinting often leads to joint stiffness and reduced patient comfort.

Purpose of the Study:

• To present a new surgical technique for treating mallet fractures of the distal phalanx.
• To evaluate the efficacy and outcomes of using a "hook" plate for open reduction and internal fixation.
• To assess the potential for early active motion and improved patient comfort.

Main Methods:

• Open reduction and internal fixation using a custom-fabricated "hook" plate from a 1.3 mm AO hand modular system.
• The technique avoids implant passage through the small avulsion fragment.
• Protected early active motion of the distal interphalangeal joint was initiated post-operatively.

Main Results:

• All nine consecutive fractures achieved bony union.
• At an average 17-month follow-up, 4 patients had excellent and 5 had good results (Crawford scale).
• All patients achieved successful outcomes per the Warren and Norris scale, with an average active flexion of 64 degrees and no extensor lag.

Conclusions:

• The "hook" plate technique provides stable fixation for mallet fractures, allowing for early mobilization.
• This method minimizes the need for prolonged splinting, enhancing patient comfort.
• The technique demonstrates high union rates and excellent functional recovery of the distal interphalangeal joint.