Purpose
We aimed to compare the clinical and radiographic results of patients with a mallet
fracture involving more than one-third of the articular surface, but without a high
degree of distal interphalangeal (DIP) joint subluxation, treated with extension block
pinning or nonsurgical management.
Methods
Forty-nine patients with a mallet fracture involving more than one-third of the articular
surface were reviewed. Twenty-six cases were treated using extension block pinning
(surgery group) and 23 were treated nonsurgically (nonsurgical group). At the final
follow-up, extension lag and flexion of the DIP joint of the affected digit were measured.
Distal interphalangeal joint pain was rated using a visual analog scale and the overall
clinical outcomes were graded using Crawford’s criteria. Complications, including
nail deformity and dorsal prominence, were also assessed. The rate of DIP joint subluxation
and fracture fragment size were radiographically evaluated.
Results
Mean extension lag and flexion of the DIP joint and mean visual analog pain scores
were not significantly different in the 2 groups. Outcomes, as assessed using Crawford’s
criteria, were excellent in 5, good in 12, fair in 6, and poor in 3 in the surgery
group, and excellent in 2, good in 11, fair in 8, and poor in 2 in the nonsurgical
group. Moreover, the frequency of nail deformity or dorsal prominence was similar
in the 2 groups. The rate of DIP subluxation and mean fracture fragment size were
similar between the 2 groups. All the fractures had united by 3 months after injury
in both groups.
Conclusions
The clinical outcomes do not significantly differ between extension block pinning
and nonsurgical management for mallet fractures involving more than one-third of the
articular surface, but without high degree subluxation of the DIP joint.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: March 05, 2017
Accepted:
February 6,
2017
Received:
September 20,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
