Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

Kim,  Byungsung; Nho,  Jae Hwi; Jung,  Ki Jin; Yun,  Keonhee; Park,  Eunseok; Park,  Sungyong

doi:2018.23.4.239

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Arch Hand Microsurg > Volume 23(4); 2018 > Article

Original Article

Archives of Hand and Microsurgery 2018;23(4):239-247.
Published online December 1, 2018.
DOI: https://doi.org/10.12790/ahm.2018.23.4.239

Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

Byungsung Kim¹, Jae-Hwi Nho², Ki Jin Jung³, Keonhee Yun¹, Eunseok Park¹, Sungyong Park⁴

¹Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
²Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
³Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
⁴Department of Orthopedic Surgery, Seogwipo Medical Center, Seogwipo, Korea. haruki0@naver.com

Received: 24 July 2018 • Revised: 14 September 2018 • Accepted: 17 September 2018

Abstract

Purpose
We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger.

Methods
Forty-six patients were included with a mean follow-up of 28 months (range, 12–54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford's criteria.

Results
Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a significant relationship between gap or step-off and extension lag. Using Crawford's evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients.

Conclusion
Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.

Key Words: Mallet finger, Extension block, Additional interfragmentary fixation, Reduction loss

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