Department of Plastic, Reconstructive and Hand Surgery, Medical Faculty, Istanbul Medeniyet University, Eğitim Mah. Dr.Erkin Cad., Kadikoy, Istanbul, Turkey.
Department of Hand and Upper Extremity Surgery, Gaziosmanpasa Hospital, Medical Faculty, Yeni Yuzyil University, Istanbul, Turkey.
Arch Orthop Trauma Surg. 2021 Apr;141(4):693-698. doi: 10.1007/s00402-021-03793-4. Epub 2021 Jan 31.
Soft-tissue mallet finger occurs due to loss of terminal extensor tendon secondary to rupture of distal phalanx. Although using noninvasive splints for 6-8 weeks is the gold standard for conservative treatment of closed soft-tissue mallet injuries, patient compliance is an important factor impacting on patient outcomes. In this study, we used a single Kirschner Wire (K-W) to fix the distal interphalangeal (DIP) joint in extension in those patients failed to comply with routine splinting.
In this prospective study, 190 patients with Doyle type 1 closed soft-tissue mallet finger deformity were included in four groups between 2011 and 2015. These groups were determined according to treatment modalities. Patients in the first group were treated with a finger splint (n = 109). Patients in the second group first received a finger splint and then K-W was applied due to lack of adequate compliance (n = 23). Patients in the third group were treated with K-W only (n = 47), and the fourth group did not accept surgical treatment nor conservative treatment (n = 11). After 20 weeks of follow up, we evaluated the results with functional measurements according to Crawford criteria and patient satisfaction. Additionally, the mid-term outcome was assessed with a follow-up at 2 years.
At 20th week postoperatively, average DIP extension lag was 6 degrees (0-30) for the first group, 6.1 degrees (0-30) for the second group, 3.8 degrees (0-25) for the third group, and 17.3 degrees (7-30) for the fourth group. Total patient satisfaction was 85%, which was considered excellent or good. Swan neck deformity was observed in 11% of patients. Osteomyelitis and KW related complications were not observed. There were no statistically significant differences between short-term and mid-term results.
Internal fixation via K-W may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients. Using this treatment approach, the success rate for patients could satisfactorily be improved.
由于远节指骨的断裂导致终末伸肌腱的丧失，会发生软组织锤状指。尽管使用非侵入性夹板固定 6-8 周是闭合性软组织锤状损伤保守治疗的金标准，但患者的依从性是影响患者结局的一个重要因素。在这项研究中，我们使用了一根克氏针（K-Wire）将远节指间关节（DIP）固定在伸展位，以治疗那些不遵守常规夹板固定的患者。
在这项前瞻性研究中，我们纳入了 2011 年至 2015 年间的 190 例 Doyle 1 型闭合性软组织锤状指畸形患者，根据治疗方法将其分为四组。第一组患者接受手指夹板治疗（n=109）。第二组患者因缺乏足够的依从性，先接受手指夹板治疗，然后应用 K-Wire（n=23）。第三组患者仅接受 K-Wire 治疗（n=47），第四组患者既未接受手术治疗，也未接受保守治疗（n=11）。在 20 周的随访后，我们根据 Crawford 标准和患者满意度对功能测量结果进行评估。此外，我们在 2 年时进行了中期随访。
术后 20 周时，第一组患者的 DIP 伸展滞后平均为 6 度（0-30），第二组为 6.1 度（0-30），第三组为 3.8 度（0-25），第四组为 17.3 度（7-30）。总满意度为 85%，认为效果极好或好。11%的患者出现天鹅颈畸形。未观察到骨髓炎和 K-Wire 相关并发症。短期和中期结果之间无统计学差异。
与夹板治疗相比，对于不依从的患者，使用 K-Wire 进行内固定可能是一种合适的治疗选择。使用这种治疗方法，可以满意地提高患者的成功率。
