Surgical Management of Delayed Mallet Finger Fractures Using Combined Two-Extension Block Kirschner Wire and Dorsal...

Area of Science:

• Orthopedics
• Hand Surgery
• Traumatology

Background:

• Delayed bony mallet fractures present challenges in achieving joint congruity.
• Previous techniques focused on acute fracture management.
• The need for effective treatment strategies for delayed presentations is critical.

Purpose of the Study:

• To assess the efficacy of a combined surgical approach for delayed bony mallet fractures.
• To evaluate the two-extension block Kirschner wire (K-wire) technique with dorsal counterforce for fracture reduction.
• To determine the feasibility of this combined technique in achieving satisfactory outcomes.

Main Methods:

• A cohort of 29 patients with delayed bony mallet fractures underwent treatment.
• Percutaneous curettage with K-wire debridement was followed by the two-extension block K-wire technique.
• Dorsal counterforce was employed for inadequate reductions; open procedures were reserved for failures.

Main Results:

• All 28 treated fractures healed within 8 weeks, with 85.7% healing within 6 weeks.
• Excellent or good functional outcomes (Crawford system) were achieved in 25 out of 28 patients (89.3%).
• The combined technique successfully restored congruent joint surfaces in most cases.

Conclusions:

• The combination of the two-extension block K-wire and dorsal counterforce techniques is a viable treatment for delayed bony mallet fractures.
• This approach facilitates congruent joint surface restoration and leads to favorable functional results.
• The technique offers a promising solution for managing these challenging fractures.