The authors reviewed 65 patients who underwent Kirschner wire fixation for the treatment of a mallet fracture. The technique involved placement of 2 converging Kirschner wires to stabilize the dorsal fracture fragment in a reduced position. Indications for surgery included the presence of a large bone fragment, palmar subluxation of the distal phalanx, loss of joint congruity, or an extension lag of more than 30 degrees. At an average follow-up of 69 weeks, there were 30 excellent, 21 good, 13 fair, and 1 poor results using the evaluation criteria of Crawford (JHS 9A:231-37, 1984). Complications involved approximately 5% of cases; 1 pin tract infection, 1 malunion, and 2 nail deformities.
The ideal treatment for a mallet fracture involving a large margin of the articular surface (>35%) remains controversial. Patients should be advised of the probability for residual joint stiffness, swelling, and post-traumatic arthritis regardless of the treatment rendered. Surgery has the potential for further stiffening the joint and has been associated with a much higher complication rate in previously published reports (Kang et al, JHS 26B:28-31, 2001.)
J Hand Surg