Schmidt B, Weinberg A, Friedrich H
Universitätsklinik für Kinderchirurgie, Medizinische Universität Graz, Osterreich.
Handchir Mikrochir Plast Chir. 2008 Jun;40(3):149-52. doi: 10.1055/s-2007-965475. Epub 2008 Jun 11.
The "mallet finger" in childhood and adolescence differs from the "mallet finger" in adults because of an open or gradually closing epiphysial plate. Thus, our results of conservative and operative treatment were evaluated particularly in consideration of an open growth plate. We analysed retrospectively the data of all patients who suffered a lesion at the extensor tendon insertion between 1996 and 2005 and were treated at our hospital. The coding was done according to age, sex, localisation, typing by Doyle, therapy and functional outcome. The typing by Doyle was extended through dividing type IV A into A1 (=Aitken I) and A2 (=Aitken II). Depending on extension deficits, the results were evaluated as very good (0 degrees ), medium (<15 degrees) and bad (>15 degrees). 76 patients, 45 boys and 31 girls aged 1 to 17 years (average age: 11.3) were studied. In consideration of the modified typing by Doyle, following distribution arose: type I (n=16), type II (n=14), type III (n=0), type IV A1 (n=17), type IV A2 (n=6), type IV B (n=21) and type IV C (n=2). A total of 50 patients was treated conservatively. Out of 26 operatively treated patients, 4 could be classified as type I, 12 as type II, 1 as type IV A1, 2 as type IV A2, 5 as type IV B, and 2 as type IV C. In 81.5 % of all patients no functional extension deficit was seen at the end of treatment; in patients treated conservatively, the percentage rate was 94 %. 6 patients, who were treated primarily operatively, showed poor functional outcome. 2 of these developed a suture track infection, in 2 cases chondral and osseous damage in the joint existed additionally, in one patient there was a comminuted fracture and in one patient a technical operative problem. Even in adolescence, conservative treatment of types I, IV A1 and A2, as well as IV B injuries is promising. A prerequisite is a consequent splint treatment and strict regular lateral X-ray control of the fracture fragment. At the beginning of treatment, we favour a plaster finger splint at an intrinsic plus position with hyperextension in the DIP joint.
儿童和青少年的“锤状指”与成人的“锤状指”不同，因为其骨骺板是开放的或逐渐闭合的。因此，我们对保守治疗和手术治疗的结果进行评估时，特别考虑了开放的生长板。我们回顾性分析了1996年至2005年期间在我院接受治疗的所有伸肌腱止点损伤患者的数据。编码依据年龄、性别、损伤部位、多伊尔分型、治疗方法和功能结果进行。多伊尔分型通过将IV A型分为A1（=艾特肯I型）和A2（=艾特肯II型）得以扩展。根据伸展功能缺损情况，结果被评估为非常好（0度）、中等（<15度）和差（>15度）。对76例年龄在1至17岁（平均年龄：11.3岁）的患者进行了研究，其中45例为男孩，31例为女孩。考虑到多伊尔改良后的分型，分布情况如下：I型（n = 16）、II型（n = 14）、III型（n = 0）、IV A1型（n = 17）、IV A2型（n = 6）、IV B型（n = 21）和IV C型（n = 2）。共有50例患者接受了保守治疗。在26例接受手术治疗的患者中，4例可归类为I型，12例为II型，1例为IV A1型，2例为IV A2型，5例为IV B型，2例为IV C型。在所有患者中，81.5%在治疗结束时未出现功能伸展缺损；保守治疗的患者中，这一比例为94%。6例最初接受手术治疗的患者功能结果较差。其中2例发生缝线通道感染，2例关节存在软骨和骨质损伤，1例患者发生粉碎性骨折，1例患者存在手术技术问题。即使在青少年时期，I型、IV A1型、IV A2型以及IV B型损伤的保守治疗也颇具前景。前提是要持续进行夹板治疗，并严格定期对骨折碎片进行侧位X线检查。在治疗开始时，我们倾向于使用手指石膏夹板，将其置于内在加位，使远侧指间关节过伸。
