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[Clinical and radiological results after operative treatment of mallet fracture using Kirschner wire technique]
L Reissner1, M Gienck, D Weishaupt
1Stadtspital Triemli, Allgemein-, Hand- und Unfallchirurgie, Zürich, Schweiz.
Background:
In our clinic dorsal distal phalanx fractures involving more than 30% of the articulare line in the lateral view are treated operatively using the Kirschner wire technique. Recently conservative treatment of these fractures is more and more recommended. Therefore we investigated in a retrospective study our patients with special regards to complications.
Purpose:
The aim of this study was to evaluate the complications, as well as the clinical and radiological results of patients after operative treatment of dorsal distal phalanx fractures using the Kirschner wire technique.
Patients And Methods:
43 patients with dorsal intraarticular fractures of the distal phalanx involving at least one third of the articular surface of the distal interphalangeal (DIP) joint were treated between 02/05 and 08/09 using Kirschner wire technique. At a mean follow-up of 28 (8-60, median 24,5) months, 32 patients were evaluated clinically and radiologically as well as with ultrasound.
Results:
5 patients developed superficial wound infections and were treated with antibiotics. 2 of these patients needed an early removal of the Kirschner wires. 2 patients showed nail deformity and 2 had an ulnar deviation of the DIP joint. The mean extension lag was 10° (0-30°, median 10°), the mean flexion lag was 19° (0-60°, median 15°). 11 patients had a flexion lag of more than 20°. 4 patients had an extension lag of more than 20°. All of these patients showed tendon tears or large lesions by ultrasound. Degenerative changes were noted in radiographs of 15 patients.
Conclusions:
Because of unsatisfactory results in 63% (n=20), conservative treatment will be our treatment of choice in the future. Operative treatment will only be done in patients with subluxation of the distal phalanx.
