Yue Zhenshuang, Mo Yafeng, Xiong Zhenfei, Tang Yanghua
Department of Orthopedics, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, China.
Zhejiang Rehabilitation Medical Center, Hangzhou, China.
Front Surg. 2023 Mar 29;10:1127827. doi: 10.3389/fsurg.2023.1127827. eCollection 2023.
The bony mallet finger is a tear fracture of the extensor tendon, resulting in a flexion deformity of the finger, which affects both the function of the finger. The classical Ishiguro's method is associated with damage to the cartilage of the distal interphalangeal (DIP) joint and always lead to the joint stiffness. This paper explores a new technique to overcome the shortcomings of the classical Ishiguro's method and achieve better clinical efficacy.
We examined 15 patients with bony mallet fingers, 9 males and 6 females, from February 2020 to June 2022, ranged from 23 to 58 years, including 1 case of index finger, 5 cases of middle finger, 3 cases of ring finger and 6 cases of little finger. The median course of the injury to surgery was 2 days (range, 1∼7 days). All had fresh closed injuries, according to the Wehbe and Schneider classification: 4 cases of type IA, 6 cases of type IB, 3 cases of type IIA and 2 cases of type IIB. All patients were treated surgically by the new technique. Post-operative follow-up was conducted to record the healing of the fracture, the pain of the affected finger and the function of joint movement.
The 15 cases were followed up after surgery. The median active range of motion was 65° (range, 55∼75°). The median extension deficit of DIP joint was 0° (range, 0∼11°). The median clinical healing time of the fracture was 6 weeks (range, 6∼10 weeks). None of the patients experienced significant pain. The patients were assessed according to the Crawford criteria at the final follow-up: 11 cases were assessed as excellent, 3 cases were assessed as good and 1 case was assessed as fair. No loss of fracture repositioning, loosening of internal fixation, skin necrosis or infection was observed.
The application of the new technique for the treatment of bony mallet fingers has the advantages of good stability, fracture healing and functional recovery of the DIP joint, making it an ideal surgical procedure for the treatment of fresh bony mallet fingers.
骨性锤状指是指伸肌腱的撕脱骨折,导致手指出现屈曲畸形,影响手指功能。经典的石黑法会损伤远侧指间(DIP)关节软骨,且常导致关节僵硬。本文探索一种新技术以克服经典石黑法的缺点并取得更好的临床疗效。
2020年2月至2022年6月,我们检查了15例骨性锤状指患者,其中男性9例,女性6例,年龄23至58岁,包括示指1例、中指5例、环指3例和小指6例。受伤至手术的中位时间为2天(范围1至7天)。所有患者均为新鲜闭合伤,根据韦布和施奈德分类:IA型4例,IB型6例,IIA型3例,IIB型2例。所有患者均采用新技术进行手术治疗。术后进行随访,记录骨折愈合情况、患指疼痛情况及关节活动功能。
15例患者术后均获随访。主动活动范围的中位值为65°(范围55至75°)。DIP关节伸直缺损的中位值为0°(范围0至11°)。骨折的中位临床愈合时间为6周(范围6至10周)。所有患者均无明显疼痛。末次随访时根据克劳福德标准对患者进行评估:优11例,良3例,可1例。未观察到骨折复位丢失、内固定松动、皮肤坏死或感染。
新技术应用于骨性锤状指的治疗,具有稳定性好、骨折愈合及DIP关节功能恢复良好的优点,是治疗新鲜骨性锤状指的理想手术方法。