![]() ![]() Regarding the bony mallet thumb injury, only few reports with a low level of evidence have been published using different surgical and non-operative fixation methods (two extension block K-wires, a hook plate, a transverse mini-plate, biodegradable devices, an Ishiguro extension block technique, a direct K-wire pinning, compression fixation pins, an extension block pinning with direct pinning, a pull-out wire fixation, a screw fixation, tension band wiring, non-operative fixation, K-wire fixation with sutures or K-wire, cast, splint, suture and screw fixation methods ).īecause the occurrence of a bony mallet thumb is a very rare condition, literature reports are limited to a few case reports or series (Table 1). Most surgeons recommend surgery for injuries involving more than one third of the articular surface and those with subluxation or displacement. The treatment of a bony mallet finger can be conservatively using different kinds of splints or surgically using different fixation methods. Additionally, difference in the tendon attachments and a tighter capsule may limit IP subluxation due to potentially more stability than the DIP joints. Also, immobilization of the interphalangeal (IP) joint of the thumb alone is not sufficient to relax the tendon in the case of a lesion. The tendon is also thicker providing a better support for possible sutures. The extensor pollicis tendon has functionally a greater extensor strength, greater excursion and a stronger tendency for retraction in the event of injury compared with the extensor digitorum tendon. This injury to the thumb differs in some features compared to the other phalanges. A mallet injury to the thumb is referred to as a “mallet thumb” and occurs quite rare, especially as an avulsion fracture. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.Īn avulsion injury of the extensor tendon of the distal interphalangeal (DIP) joint is also called “bony mallet injury/deformity” or “mallet fracture”. ![]() On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. The evidence for the best treatment of a bony mallet thumb fracture is low. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. An open reduction led to worse functional scores compared to a closed reduction. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. Surgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb ( n = 21 articles). The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Patients and methodsĪll patients ( n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method. ![]()
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