Pull-out wire fixation for acute mallet finger fractures with k-wire stabilization of the distal interphalangeal joint

Abstract

Purpose: The aim of this study was to describe and assess a surgical technique for the treatment of mallet finger fractures using a pull-out wire with K-wire stabilization of the distal interphalangeal (DIP) joint in extension.

Methods: From May 2003 to January 2008, we performed pull-out wire fixation of the fracture fragment with stabilization of the DIP joint using a K-wire in 65 closed mallet finger fractures in 65 patients with a mean age of 32 years (range, 18-48). The mean time between the injury and surgery was 8 days (range, 0-19 d). In this cohort, the mean joint surface involvement was 39% (range, 30% to 49%) and all injuries were associated with DIP joint subluxation. Fifteen days after surgery, the digits were assessed for skin necrosis, skin breakdown, and wound and wire track infection. Patient follow-up lasted 24 to 27 months, with a mean period of 25.5 months. The fingers were assessed for loss of extension and flexion of the DIP joints. We graded the results using Crawford's criteria.

Results: Fracture reduction was maintained and all fractures united. We found no skin necrosis, skin breakdown, infection, or nail deformities. At the final follow-up, the mean extensor loss of the DIP joints was 7° (range, 0° to 37°). The mean flexion loss of the DIP joints was 1° (range, 0° to 15°). We noted extensor loss of the joint less than 10° in 57 digits and 10° to 15° (mean, 13°) in 8 digits. Based on Crawford's criteria, 52 digits were excellent, 8 were good, 4 were fair, and one was poor.

Conclusions: Pull-out wire fixation of the reduced fracture fragment and K-wire stabilization of the DIP joint is a useful technique for the treatment of mallet finger fractures.

Type of study/level of evidence: Therapeutic IV.