Kuşcu Burak, Gürbüz Kaan
Department of Orthopedics and Traumatology, Bandırma Special Royal Hospital, Balıkesir-Türkiye.
Depatment of Orthopedics and Traumatology Kayseri Education and Research Hospital, Kayseri-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2025 Jan;31(1):84-94. doi: 10.14744/tjtes.2024.15332.
Mallet finger injuries, characterized by a flexion deformity caused by trauma to the extensor mechanism at the base of the distal phalanx, can lead to significant functional impairment if not treated appropriately. Surgical interventions for osseous mallet finger injuries often include techniques such as extension-block pinning and perioperative modifying plate fixation. When comparing these two methods, it is critical to assess factors such as technical ease, perioperative considerations, and postoperative outcomes. This study aims to compare these two techniques to provide valuable insights into the optimal surgical approach for treating osseous mallet finger injuries, improving patient care and outcomes.
From 2017 to 2022, a retrospective study of 89 patients with Doyle classification type IVB and IVC mallet finger injuries was conducted. The patients were divided into two groups using a surgical technique called block randomization. Group 1 included 46 patients treated with the extension-block pinning fixation technique, while Group 2 comprised 43 patients treated with the perioperative modifying plate fixation technique. Observations included nail deformities and dorsal prominence at the distal interphalangeal (DIP) joint.
All patients were deemed eligible for surgical intervention due to the time elapsed since injury or ineffectiveness of prior conservative treatment. No significant differences in patient demographics were observed between the two groups. While Crawford classification and pain scores showed no significant differences between the groups (p>0.05), the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score and time to return to work significantly favored Group 2, which underwent perioperative modifying plate fixation (p<0.05).
Extension-block pinning is noted for its simplicity and favorable postoperative range of motion outcomes. In contrast, perioperative modifying plate fixation enhances stability and mechanical performance, positively impacting overall functional recovery. The choice between these techniques should consider procedural simplicity, perioperative demands, mechanical efficiency, and postoperative functional outcomes.
锤状指损伤的特征是远端指骨基部伸肌机制受创伤导致屈曲畸形，若未得到恰当治疗可导致严重功能障碍。骨性锤状指损伤的手术干预通常包括诸如伸展阻挡穿针固定和围手术期改良钢板固定等技术。比较这两种方法时，评估技术难易程度、围手术期注意事项和术后结果等因素至关重要。本研究旨在比较这两种技术，为治疗骨性锤状指损伤的最佳手术方法提供有价值的见解，改善患者护理和治疗结果。
2017年至2022年，对89例多伊尔（Doyle）分类IVB型和IVC型锤状指损伤患者进行了一项回顾性研究。采用一种名为区组随机化的手术技术将患者分为两组。第1组包括46例采用伸展阻挡穿针固定技术治疗的患者，而第2组包括43例采用围手术期改良钢板固定技术治疗的患者。观察指标包括指甲畸形和远端指间关节（DIP）处的背侧隆起。
由于受伤后经过的时间或先前保守治疗无效，所有患者均被认为适合手术干预。两组患者人口统计学特征无显著差异。虽然克劳福德（Crawford）分类和疼痛评分在两组之间无显著差异（p>0.05），但手臂、肩部和手部快速残疾量表（Q-DASH）评分以及恢复工作时间明显有利于接受围手术期改良钢板固定的第2组（p<0.05）。
伸展阻挡穿针以其操作简单和术后活动范围良好的结果而闻名。相比之下，围手术期改良钢板固定增强了稳定性和力学性能，对整体功能恢复产生积极影响。这些技术之间的选择应考虑手术操作的简单性、围手术期需求、力学效率和术后功能结果。
