Tetik Cihangir, Gudemez Eftal
Department of Orthopedic Surgery and Traumatology, Marmara University Faculty of Medicine, Altunizade, Istanbul, Turkey.
Clin Orthop Relat Res. 2002 Nov(404):284-90. doi: 10.1097/00003086-200211000-00043.
A modification of the extension block Kirschner wire technique that is used for closed reduction of mallet fractures is described. Eighteen mallet avulsion fractures of the distal phalanx treated with this modification were included in this prospective study. The fingers affected were nine small fingers, eight ring fingers, and one long finger. Surgical indications included fractures involving more than 33% of the articular surface and fractures associated with subluxation of the distal phalanx that could not be corrected by closed reduction. The average joint surface involvement was 39.8%. At followup, only one patient had pain, and that was graded as minimal. Objectively, congruous and satisfactory joint surfaces were present in 17 patients. No patient had pseudarthrosis. The average active flexion of the distal interphalangeal joint was 81.1 degrees and the average extensor lag was 1.6 degrees. Neither pin tract infections nor migration of the pins occurred. The average followup was 27.3 months. This modification increased range of motion at the distal interphalangeal joint and showed a trend toward reduced permanent extensor lag when compared with the original method. This technique should be considered when treatment of the mallet fracture is being planned using the extension block Kirschner wire technique.
本文描述了一种用于闭合复位锤状指骨折的改良延长块克氏针技术。本前瞻性研究纳入了18例采用该改良技术治疗的远端指骨锤状撕脱骨折患者。受累手指包括9根小指、8根环指和1根示指。手术指征包括累及超过33%关节面的骨折以及伴有远端指骨半脱位且无法通过闭合复位纠正的骨折。平均关节面受累比例为39.8%。随访时，仅1例患者有疼痛，且疼痛程度为轻度。客观上，17例患者的关节面平整且令人满意。无患者发生假关节。远端指间关节的平均主动屈曲度为81.1度，平均伸肌滞后为1.6度。未发生针道感染和克氏针移位。平均随访时间为27.3个月。与原方法相比，该改良技术增加了远端指间关节的活动度，并显示出减少永久性伸肌滞后的趋势。在计划采用延长块克氏针技术治疗锤状指骨折时，应考虑该技术。
