The authors treated 48 mallet fractures by closed reduction and percutanous pinning. Their technique involved placing a K-wire across the fracture, bending the proximal end of the wire into the shape of an “umbrella handle,” and drawing the distal end of the wire through the finger pulp. All 48 fractures measured greater than 1/3rd of the joint surface, and 41 fractures were associated distal interphalangeal (DIP) joint subluxation. The pin was removed at 6 weeks: a pin site infection developed in 1 case requiring early pin removal. At 2 months follow-up, 11 fingers demonstrated full DIP joint motion, 35 fingers had an average DIP joint extension lag of 6 degrees, and 2 fingers demonstrated a DIP joint extension lag of 20 degrees. Follow-up assessment at 1 year was performed in 46 cases: the clinical results were unchanged.
Several techniques for repair of large mallet fractures (>1/3rd joint surface), with or without DIP joint subluxation, have been described. However, the necessity for surgical repair of these injuries remains controversial. High complication rates have been reported with operative treatment (Kang et al., JHS, 2001). Additionally, the DIP joint has a known propensity to remodel (Schneider, Hand Clin, 1994). A dorsal DIP joint prominence, terminal extensor lag, and swan neck deformity of the digit may develop, regardless of the treatment method chosen. These changes may have negligible effect on patient satisfaction or hand function (Kalainov et al, JHS, 2005).
Mallet, Fracture, Phalanx, Umbrella
Journal of Hand Surgery