Clinical and Radiographic Outcomes of the Wrap-Around Extension Block Pinning Technique for Bony Mallet Fingers

Aims and objectives Mallet finger fractures with substantial dorsal fragments often require surgical intervention, particularly when associated with distal interphalangeal joint (DIPJ) subluxation. We evaluated the clinical outcomes of a modified fixation method, the wrap-around extension block pinning technique, designed to enhance dorsal fragment compression and reduce K-wire migration. Materials and methods We conducted a retrospective cohort study of all consecutive patients treated with the wrap-around technique at a single tertiary hand surgery center over five years. Seventeen patients with a minimum follow-up of four months were included. Demographic, clinical, and radiographic data were analyzed. Outcomes were assessed using Crawford's criteria, and the results were benchmarked against historical controls (Çapkın et al., Jain et al., and the surgical and conservative subgroups of Yoon et al.). Graphical analyses were used to visually explore the potential trend between the mean cohort age and outcome distributions. Results Seventeen patients (mean age, 39 years) were analyzed. The combined excellent/good rate was 41.1% (7/17), and no postoperative complications occurred in this cohort (0%; 0/17), with no cases of hardware failure or loss of reduction. Comparative descriptive analysis suggested an inverse trend between cohort mean age and the proportion of excellent/good outcomes across the analyzed studies, with younger published cohorts demonstrating higher excellent/good rates. The outcome distribution in the current series most closely resembled that of the surgically treated subgroup in Yoon et al., which also included older patients and more complex fracture patterns. Conclusion The wrap-around extension block pinning technique provided exceptionally stable fixation without complications but did not yield superior functional outcomes compared with the historical results of standard extension block pinning. Our observations suggest that age, fracture severity, and immobilization duration may be more strongly associated with functional recovery than the specific fixation constructs. While further comparative studies are needed, the technique offers a reliable alternative when construct stability is a priority.