The Versatile Hook Plate in Avulsion Fractures of the Hand

Avulsion fractures can pose technical difficulties for surgical fixation. The fragments are often small and around finger joints with access being difficult due to attachment of ligaments or tendons. Traditionally, these have been treated using K wires, lag screws, or pullout sutures.Hook plates were originally described for operative management of mallet fractures. We have been using hook plates in our unit for over 10 years. However, over the years, we have extended their use to other avulsion fractures in the hand such as proximal interphalangeal joint fracture dislocations, central slip avulsions, flexor digitorum profundus avulsions and collateral ligament avulsions.The aim of this article is to describe the technique of fabricating a hook plate and using it for avulsion fractures in the hand. A few illustrative cases are discussed along with a review of the current literature.

In a retrospective review of our use of hook plates in hand fractures from 2008 to 2014, a total of 63 cases were identified from the hospital data base. There were 35 cases of Mallet fractures, 16 cases of proximal interphalangeal joint fracture dislocations, 5 cases of flexor digitorum profundus avulsion fractures, 5 cases of Central slip avulsions, and 2 collateral ligament avulsions.

All fractures healed well with this technique with no biomechanical failures and good functional outcome. Plates needed removal in a total of 25 cases, of which 14 were in mallet fractures. Thirteen (21%) cases suffered complications, of which the majority were again related to mallet fractures.

The hook plate is a simple device that can be created quite easily with readily available materials. We have extended the use of these plates to avulsion fracture fixation in the hand and found this to be a versatile technique. The risk of fragmenting the small fracture fragment is reduced because the hooks secure it and the plate is fixed in the bone. If done meticulously, joint congruence can be achieved. It has a biomechanical advantage over current methods of fracture fixation of small but important bone fragments in the hand.