Wang Wei-Chih, Hsu Cheng-En, Yeh Chen-Wei, Ho Tsung-Yu, Chiu Yung-Cheng
School of Medicine, China Medical University, Taichung, Taiwan.
Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, Taiwan, 404472, Taichung, Taiwan.
BMC Musculoskelet Disord. 2021 Mar 16;22(1):281. doi: 10.1186/s12891-021-04163-2.
The treatment of mallet fracture using hook plate fixation was first introduced in 2007 and has subsequently shown excellent outcomes. Common complications, such as nail deformity and screw loosening, have also been reported. Very few studies have focused on these common complications or their prevention. In this study, we present the clinical outcomes and complications of our case series and describe the pitfalls and detailed solution of surgical tips to avoid common complications related to this procedure.
The retrospective case series of 16 patients with mallet fractures who underwent open reduction and hook plate fixation in our hospital from 2015 to 2020 were retrospectively reviewed. Data on extension lag, range-of-motion (ROM) of the distal interphalangeal joint (DIP) joint, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and surgical complications were collected and analysed. The clinical outcome was graded according to the Crawford mallet finger criteria.
Sixteen patients were included in our analysis. The median DIP extension lag was 0° (range, 0° to 30°) and the median active DIP flexion angle was 60° (range, 40° to 90°). The median DASH score was 0 (range, 0-11.3). Fourteen patients with good and excellent results were satisfied with this treatment. The Complication rate in our patient series was 18%. Common complications reported in articles included wound necrosis, extension lag, nail deformity, and plate loosening.
Despite the fact that the treatment of mallet fracture with hook plate fixation has satisfactory functional outcomes, pitfalls, including iatrogenic nail germinal matrix injury, unnecessary soft tissue dissection, and insufficient screw purchase, were still reported. To avoid complications, we suggest modifications of the skin incision, soft tissue dissection, and screw position.
钩钢板固定治疗锤状指骨折于2007年首次引入，随后显示出良好的疗效。也有报道称出现了一些常见并发症，如指甲畸形和螺钉松动。很少有研究关注这些常见并发症或其预防措施。在本研究中，我们展示了我们病例系列的临床结果和并发症，并描述了手术技巧中的陷阱以及避免该手术相关常见并发症的详细解决方案。
回顾性分析了2015年至2020年在我院接受切开复位和钩钢板固定的16例锤状指骨折患者的病例系列。收集并分析了关于伸展滞后、远侧指间关节（DIP）活动范围（ROM）、上肢、肩部和手部功能障碍（DASH）评分以及手术并发症的数据。根据克劳福德锤状指标准对临床结果进行分级。
16例患者纳入我们的分析。DIP伸展滞后的中位数为0°（范围为0°至30°），主动DIP屈曲角度的中位数为60°（范围为40°至90°）。DASH评分的中位数为0（范围为0 - 11.3）。14例结果为优和良的患者对该治疗满意。我们患者系列中的并发症发生率为18%。文章中报道的常见并发症包括伤口坏死、伸展滞后、指甲畸形和钢板松动。
尽管钩钢板固定治疗锤状指骨折具有令人满意的功能结果，但仍报道了一些陷阱，包括医源性甲母质损伤、不必要的软组织剥离和螺钉固定不足。为避免并发症，我们建议对皮肤切口、软组织剥离和螺钉位置进行改进。
