Benabdallah Otman, Benabdallah Rania
Department of Orthopaedics and Traumatology, Centres Hospitaliers de Tanger, Tangier, Morocco.
Department of Gastroenterology and Emergency, Hospital Principe de Asturias, Madrid, Spain.
J Orthop Case Rep. 2022 Nov;12(11):60-64. doi: 10.13107/jocr.2022.v12.i11.3416.
Mallet finger is a frequent lesion. It represents 2% of sports emergencies and is the most common closed tendon injury seen in contact sports or in work environment. It occurs always after a traumatic etiology. Our case is atypical and exceptional, because it is caused by a villonodular synovitis, condition which has been never reported in the literature.
A 35-year-old woman presented for a mallet finger deformity of the second right finger. When questioned, the patient did not recall any trauma; she reported that the deformation had developed gradually over a period of more than 20 days preceding the definitive deformation of the finger into a classic mallet finger. She reported experiencing mild pain before the deformation, with burning sensations at the third finger phalanx. On palpation, we noted the presence of nodules at the level of the distal interphalangeal joint and on the dorsal face of the second phalanx of the concerned finger. The X-ray examination showed the classic mallet finger deformity, with no bone associated lesion. The diagnosis of pigmented villonodular synovitis (PVNS) was suspected intraoperatively by the presence of hemosiderin into the tendon sheath and distal articulation. The excision of the mass with tenosynovectomy and reinsertion of the tendon was the essential elements of the treatment.
A mallet finger caused by a villonodular tumor is an exceptional condition with local aggressivity and uncertain prognosis. A meticulous surgical procedure could achieve an excellent result. Complete tenosynovectomy, tumor surgical resection, and tendon reinsertion were the mainstay of treatment for a long-lasting excellent result.
锤状指是一种常见的损伤。它占运动急症的2%，是接触性运动或工作环境中最常见的闭合性肌腱损伤。它总是由创伤性病因引起。我们的病例是非典型且罕见的，因为它是由绒毛结节性滑膜炎引起的，这种情况在文献中从未有过报道。
一名35岁女性因右手第二指锤状指畸形前来就诊。询问时，患者不记得有任何外伤；她报告说，在手指最终变形为典型锤状指之前的20多天里，畸形是逐渐发展的。她报告在变形前有轻微疼痛，在第三指骨处有烧灼感。触诊时，我们注意到在患指远侧指间关节水平和第二指骨背侧有结节。X线检查显示典型的锤状指畸形，无相关骨病变。术中因腱鞘和远侧关节内存在含铁血黄素而怀疑为色素沉着绒毛结节性滑膜炎（PVNS）。切除肿块并进行腱鞘切除和肌腱重新附着是治疗的关键步骤。
由绒毛结节性肿瘤引起的锤状指是一种罕见的情况，具有局部侵袭性且预后不确定。细致的手术操作可取得良好效果。彻底的腱鞘切除、肿瘤手术切除和肌腱重新附着是获得长期良好效果的主要治疗方法。
