Malleus-handle fracture: historical review and three new cases

Isolated malleus-handle fracture is a clinical entity seldom reported in the medical literature but well known in the last century. The purpose of this paper was to review the literature over the last 150 years and describe three new cases.

Extensive review of the literature and chart review of three patients with isolated malleus-handle fracture.

The study was performed partly at a private practice and partly in an academic tertiary referral center.

At least 43 malleus-handle fractures have been reported in the literature. Three new occurrences were studied.

The review of the literature showed that head trauma with skull base fracture was the most frequent cause of malleus-handle fracture, followed by blows on the tympanic membrane and barotrauma, penetration of pen-holders or hair pins, penetration of twigs, and attempts to remove a foreign body pushed inside the ear. In the first patient reported here, the malleus-handle fracture was caused by a whirlpool bath, in the second, the cause was unknown, and, in the third, it was caused by a brisk decompression inside the ear canal.

This lesion is not rare, and the diagnosis frequently is missed because the tympanic membrane appears intact. A careful otoscopic examination with pneumomassage, an abnormally high compliance at tympanometry, and a carefully recorded medical history may lead to the diagnosis of isolated malleus-handle fracture in a patient with a mild conductive hearing loss.