Tuttle Harrison G, Olvey Scott P, Stern Peter J
Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Clin Orthop Relat Res. 2006 Apr;445:157-68. doi: 10.1097/01.blo.0000205903.51727.62.
Mallet injuries are the result of incompetence of the terminal tendon. Most acute mallet fingers can be treated by continuous splinting of the distal interphalangeal (DIP) joint in extension for 5-6 weeks. Fracture dislocations require open reduction and internal fixation. Treatment of chronic mallet injuries must be individualized. If there is a flexible swan neck deformity, spiral oblique ligament reconstruction is indicated. For a fixed contracture, DIP joint arthrodesis is preferred. Profundus avulsion injuries, or jersey finger, seen within 10 days of injury require operative reattachment of the profundus tendon. Treatment of avulsions more than 10-14 days after injury must be individualized and depends on location of the stump (palm vs. digit), time from injury, passive mobility of the digit, and individual functional demands. Chronic avulsions, where the stump is distal to the proximal interphalangeal joint can often be advanced secondarily. Other options include no treatment, stump excision with or without DIP joint arthrodesis, or flexor tendon reconstruction with a free graft.
Therapeutic study, Level V (Expert opinion).
锤状指损伤是指末节肌腱功能不全所致。多数急性锤状指可通过持续将远侧指间关节（DIP）伸直位夹板固定5 - 6周进行治疗。骨折脱位则需要切开复位内固定。慢性锤状指损伤的治疗必须个体化。若存在可复性鹅颈畸形，则需行螺旋斜韧带重建术。对于固定性挛缩，首选DIP关节融合术。在损伤10天内发现的指深屈肌腱撕脱伤，即“球衣指”，需要手术重新附着指深屈肌腱。损伤10 - 14天以上的撕脱伤治疗必须个体化，取决于残端位置（手掌与手指）、受伤时间、手指被动活动度及个体功能需求。慢性撕脱伤，若残端位于近端指间关节远侧，通常可二期推进修复。其他选择包括不治疗、残端切除（可伴或不伴DIP关节融合术）或用游离移植物进行屈肌腱重建。
治疗性研究，V级（专家意见）。
