Twelve patients with mallet fractures treated by open reduction and internal fixation with small screws (0.8mm) were reviewed at a mean of 31 months after surgery (range 6 months - 9 years). Indications for surgery included fractures involving more than one-third of the distal phalanx articular surface, and fractures with subluxation of the distal interphalangeal joint. Loss of reduction occurred in only 1 patient. There were no nail deformities, infections, or secondary operations. The final range of distal interphalangeal joint motion averaged 6 to 70 degrees with a residual extensor lag measuring from 0 to 30 degrees. The authors concluded that open reduction and screw fixation of mallet fractures with small screws may lead to satisfactory outcome in select patients.
Treatment of mallet fractures remains a controversial topic; there are presently no large series treated either operatively or non-operatively to guide treatment choice. Although satisfactory results can be expected with splinting alone, operative treatment has been suggested for fractures involving more than one-third of the articular surface and fractures with palmar subluxation. However, complications of surgery are reportedly frequent and include infection, joint stiffness, nail plate deformity, wound dehiscence, pulp scarring, pulp pain, non-union, and malunion (Stern and Kastrup, JHS, 1988). Non-operative treatment remains the treatment of choice in the vast majority of these injuries. This joint has a unique ability to remodel and function adequately despite initial fragment displacement.
Journal of Hand Surgery