Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury

This study aimed to evaluate the clinical outcomes of surgical treatment for chronic mallet injury with severe extension lag using an anatomic reconstruction of the terminal tendon and lateral band with a palmaris longus (PL) tendon graft.

Eleven patients with a mean age of 52 years (range, 24-82 years) who underwent surgical reconstruction for chronic tendon mallet injuries using the PL tendon were included. The harvested PL tendon was either folded longitudinally or divided into two slips. The graft was secured to the distal phalanx using a bone anchor and sutured to the soft tissues and remnants of the original terminal tendon distal to the distal interphalangeal (DIP) joint. Each half-slip tendon was passed under the transverse retinacular ligament and sutured side-to-side to the lateral band at approximately the midpoint of the proximal phalanx. The active range of motion of the affected finger was evaluated before and after surgery, and any complications were recorded.

Before surgery, the extension of the DIP joint averaged -49.5° (range, -40° to -60°). The postoperative mean lag of the DIP joint improved to -7.8° (range, -20° to +20°). According to the Miller classification, four patients had excellent results, four had good results, and three had fair results. Two patients who underwent folded-PL tendon grafting developed superficial dorsal skin infections on the little finger that resolved with oral antibiotics or removal of the sutures.

Anatomical reconstruction of the terminal tendon and lateral bands using a PL tendon graft yielded satisfactory outcomes in chronic tendon mallet injuries. Dividing the PL tendon into two slips is recommended to reduce the risk of postoperative infection.

Therapeutic IV.