UNASSIGNED: The bony mallet finger is a tear fracture of the extensor tendon, resulting in a flexion deformity of the finger, which affects both the function of the finger. The classical Ishiguro\'s method is associated with damage to the cartilage of the distal interphalangeal (DIP) joint and always lead to the joint stiffness. This paper explores a new technique to overcome the shortcomings of the classical Ishiguro\'s method and achieve better clinical efficacy.
UNASSIGNED: We examined 15 patients with bony mallet fingers, 9 males and 6 females, from February 2020 to June 2022, ranged from 23 to 58 years, including 1 case of index finger, 5 cases of middle finger, 3 cases of ring finger and 6 cases of little finger. The median course of the injury to surgery was 2 days (range, 1∼7 days). All had fresh closed injuries, according to the Wehbe and Schneider classification: 4 cases of type IA, 6 cases of type IB, 3 cases of type IIA and 2 cases of type IIB. All patients were treated surgically by the new technique. Post-operative follow-up was conducted to record the healing of the fracture, the pain of the affected finger and the function of joint movement.
UNASSIGNED: The 15 cases were followed up after surgery. The median active range of motion was 65° (range, 55∼75°). The median extension deficit of DIP joint was 0° (range, 0∼11°). The median clinical healing time of the fracture was 6 weeks (range, 6∼10 weeks). None of the patients experienced significant pain. The patients were assessed according to the Crawford criteria at the final follow-up: 11 cases were assessed as excellent, 3 cases were assessed as good and 1 case was assessed as fair. No loss of fracture repositioning, loosening of internal fixation, skin necrosis or infection was observed.
UNASSIGNED: The application of the new technique for the treatment of bony mallet fingers has the advantages of good stability, fracture healing and functional recovery of the DIP joint, making it an ideal surgical procedure for the treatment of fresh bony mallet fingers.

UNASSIGNED: To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers.
UNASSIGNED: Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with one-stage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years (range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in 7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours (mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint (DIPJ) was (40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at 6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started.
UNASSIGNED: The operation time was 35-55 minutes (mean, 43.9 minutes). The length of hospital stay was 2-5 days (mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months (mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks (mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale (VAS) score of pain during active flexion of the DIPJ was 1-3 (mean, 1.6); the VAS score of pain was 2-5 (mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was (2.14±2.54)°, showing significant difference when compared with preoperative angle (t=52.186, P<0.001). There was no significant difference in the active flexion angle between the affected finger (79.52±6.31)° and the corresponding healthy finger (81.90±5.36)° (t=1.319, P=0.195). At 6 months after operation, according to Crawford functional evaluation criteria, the effectiveness was rated as excellent in 11 cases, good in 9, and fair in 1, with an excellent and good rate of 95.24%.
UNASSIGNED: For Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers, one-stage closed reduction and elastic compression fixation with double Kirschner wires can effectively correct the deformity and has the advantages of simple surgery, no incision, and no influence on the appearance of the affected finger.
UNASSIGNED: 探讨一期闭合复位双克氏针弹性加压固定治疗Wehbe-Schneider ⅠB、ⅡB型骨性锤状指的疗效。.
UNASSIGNED: 2017年5月—2020年6月，采用一期闭合复位双克氏针弹性加压固定治疗21例Wehbe-Schneider ⅠB、ⅡB型骨性锤状指患者。男15例，女6例；年龄19～62岁，平均39.2岁。致伤原因：运动伤9例，戳伤7例，扭伤5例。受伤至入院时间5～72 h，平均21.0 h。损伤指别：示指2例，中指8例，环指9例，小指2例。远端指间关节（distal interphalangeal joint，DIPJ）主动背伸丧失角度为（40.04±4.02）°。根据Wehbe-Schneider分型标准：ⅠB型10例，ⅡB型11例。术后6周待X线片复查示撕脱骨折达骨性愈合后取出克氏针，并开始患指功能锻炼。.
UNASSIGNED: 手术时间35～55 min，平均43.9 min；住院时间2～5 d，平均3.4 d。术后无相关并发症发生。患者均获随访，随访时间6～12个月，平均8.8个月。X线片复查示撕脱骨折均达骨性愈合，愈合时间4～6周，平均5.3周。术后6周取出克氏针后，DIPJ主动屈曲时疼痛视觉模拟评分（VAS）为1～3分，平均1.6分；被动屈曲至最大活动度时为2～5分，平均3.1分。患指DIPJ主动背伸丧失角度为（2.14±2.54）°，与术前比较差异有统计学意义（t=52.186，P<0.001）。患指DIPJ主动屈曲角度为（79.52±6.31）°，与对应健指（81.90±5.36）° 比较，差异无统计学意义（t=1.319，P=0.195）。术后3个月，根据Crawford功能评定标准评价，疗效达优11例、良9例、一般1例，优良率为95.24%。.
UNASSIGNED: 对于Wehbe-Schneider ⅠB、ⅡB型骨性锤状指，一期闭合复位双克氏针弹性加压固定可有效纠正畸形，具有操作简便、手术无切口不影响患指外观等优点。.

This retrospective study evaluated procedural failures of closed reductions using an extension-block Kirschner wire (K-wire) for bony mallet finger. A total of 132 patients who underwent a closed reduction for bony mallet finger in a procedure using an extension-block K-wire were radiographically assessed. Radiographs were used to evaluate (1) postoperative displacement of the reduction before or after K-wire removal and (2) inaccurate reduction of the fragment immediately after surgery. The causes of procedural failure and bone union were evaluated using radiographs and medical records of the intraoperative findings. Out of 132 patients, 17 with procedural failure were enrolled. Displacement of the reduction before and after K-wire removal occurred in seven and six cases, respectively. Inaccurate reduction immediately after surgery occurred in four cases. The most common cause of procedural failure was inaccurate insertion of the K-wire to fix the distal interphalangeal joint (eight cases) followed by inaccurate insertion of the extension-block pin (five cases). All patients had bone union regardless of the displacement of the reduction or inaccurate reduction of the fragment. Caution should be exercised during the reduction and fixation when an extension-block K-wire is used in a closed reduction procedure.

BACKGROUND: The treatment of mallet fracture using hook plate fixation was first introduced in 2007 and has subsequently shown excellent outcomes. Common complications, such as nail deformity and screw loosening, have also been reported. Very few studies have focused on these common complications or their prevention. In this study, we present the clinical outcomes and complications of our case series and describe the pitfalls and detailed solution of surgical tips to avoid common complications related to this procedure.
METHODS: The retrospective case series of 16 patients with mallet fractures who underwent open reduction and hook plate fixation in our hospital from 2015 to 2020 were retrospectively reviewed. Data on extension lag, range-of-motion (ROM) of the distal interphalangeal joint (DIP) joint, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and surgical complications were collected and analysed. The clinical outcome was graded according to the Crawford mallet finger criteria.
RESULTS: Sixteen patients were included in our analysis. The median DIP extension lag was 0° (range, 0° to 30°) and the median active DIP flexion angle was 60° (range, 40° to 90°). The median DASH score was 0 (range, 0-11.3). Fourteen patients with good and excellent results were satisfied with this treatment. The Complication rate in our patient series was 18%. Common complications reported in articles included wound necrosis, extension lag, nail deformity, and plate loosening.
CONCLUSIONS: Despite the fact that the treatment of mallet fracture with hook plate fixation has satisfactory functional outcomes, pitfalls, including iatrogenic nail germinal matrix injury, unnecessary soft tissue dissection, and insufficient screw purchase, were still reported. To avoid complications, we suggest modifications of the skin incision, soft tissue dissection, and screw position.

The aim of this study was to investigate the reliability of distal interphalangeal joint (DIPJ) subluxation and articular surface involvement measurements during the assessment of bony mallet finger. Two observers measured articular involvement, subluxation ratio and rated joint congruency on 30 lateral radiographs of patients with bony mallet finger on two separate occasions. All measurements and ratings were done on magnified digital radiographs on a workstation. The intraclass correlation coefficient (ICC) and kappa statistics were used to establish relative agreement between observers. The intra-observer reliability for articular involvement and subluxation ratio were good for Observer A (ICCs 0.888 and 0.775) and excellent for Observer B (ICCs 0.958 and 0.910) on both occasions. However, the subluxation rating was moderate for both observers (kappa 0.772 and 0.780, respectively). Inter-observer reliability for articular involvement (ICC 0.884) and the subluxation ratio (ICC 0.818) was good on the first measurement. Although the subluxation rating was perfect for the first measurement (kappa 0.927), it was moderate for the second (kappa, 0.619). The reliability of articular involvement (%) and subluxation ratio (%) measurement was good and excellent. However, the decision on whether the DIPJ is congruent or incongruent was only moderately reproducible. These findings show us that surgeons should be cautious when assessing subluxation, which is the most important criterion for choosing the appropriate treatment.

UNASSIGNED: Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in a case of mallet finger with fracture fragment involving more than one-third of the distal phalanx articular surface. This is the first reported case of mallet fracture treated with delta wiring in literature.
UNASSIGNED: A 30-year-old male patient admitted in our institute with complaints of severe pain in the right index finger with inability to extend the distal interphalangeal joint (DIP) for 5 days. There was a history of fall from the bike before this complaint. Radiographs revealed a bony mallet fracture involving more than one-third of the articular surface of distal phalanx. The patient was taken up for delta wiring fixation of the fracture. Radiographic bony union was seen at 7 weeks. At the final follow-up at 1 year, DIP had 75° of flexion and had extension deficit of 5°. According to Crawford\'s criteria, the patient had good results with a VAS score of 1 with no pain.
UNASSIGNED: Delta wiring technique is a new and safe treatment modality for bony mallet fracture with fracture fragment involving more than one-third of the distal phalanx articular surface as satisfactory clinical and radiological outcomes obtained in our case.

OBJECTIVE: To investigate the effectiveness of modified Ishiguro technique with strengthening pressure in the treatment of bony mallet finger by comparing with the traditional Ishiguro technique.
METHODS: Between May 2013 and May 2015, 31 cases of bony mallet finger were treated with traditional Ishiguro technique in 16 cases (control group) and with modified Ishiguro technique in 15 cases (improved group, the two Kirschner wires were bound, which were used to fix the distal interphalangeal joint and blocking avulsion fracture block in the classical Ishiguro technique, and play a continuous elastic compression). Difference was not significant in gender, age, cause of injury, injury finger, and the time from injury to operation between 2 groups (P > 0.05).
RESULTS: The wound healing was delayed in 2 cases of the control group and 1 case of the improved group, and the other patients obtained healing by first intension. The follow-up time was 8-23 months (mean, 11 months) in the improved group and was 9-24 months (mean, 12 months) in the control group. Bending deformation of the Kirschner wire occurred in 2 cases of the control group, obvious separation was found between fracture fragment and the distal phalanx; after manual reduction, brace was used to fix, and distal interphalangeal arthritis occurred during follow-up. The fracture healing time was (6.8±0.8) weeks in the control group, and was (5.7±1.5) weeks in the improved group. There was significant difference in the healing time between 2 groups (t=-2.439, P=0.021). At last follow-up, according to Crawford criteria, the results were excellent in 9 cases, good in 4 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 81.25% in the control group; the results were excellent in 10 cases, good in 3 cases, and fair in 2 case with an excellent and good rate of 86.67% in the improved group. There was no significant difference in excellent and good rate between 2 groups (Z=-0.636, P=0.525).
CONCLUSIONS: Compared with traditional Ishiguro technique, the modified Ishiguro technique with strengthening pressure in treatment of bony mallet finger can facilitate the fracture healing, reduce Kirschner wire loosening and deformation, and decrease the rates of operation failure and complications.
UNASSIGNED: 通过与经典石黑法比较，探讨改良加压石黑法治疗骨性锤状指的临床疗效。.
UNASSIGNED: 回顾分析2013年5月－2015年5月手术治疗的31例骨性锤状指患者临床资料，其中16例采用经典石黑法（对照组），15例采用改良加压石黑法（固定远指间关节和阻挡撕脱骨折块的2枚克氏针远端用皮筋捆绑，起到持续弹性加压作用）。两组患者性别、年龄、致伤原因、损伤指别、受伤至手术时间等一般资料比较，差异均无统计学意义（P > 0.05），具有可比性。.
UNASSIGNED: 术后对照组2例、改良组1例切口延迟愈合，其余患者切口均Ⅰ期愈合。患者均获随访，改良组随访时间为8～23个月，平均11个月；对照组为9～24个月，平均12个月。对照组术后1个月内2例克氏针弯曲变形，骨折块与远节指骨分离明显，手法复位后重新支具固定，经随访出现远指间关节炎；其余患者骨折均愈合，愈合时间为（6.8±0.8）周。 改良组骨折均顺利愈合，愈合时间为（5.7±1.5）周；未发生克氏针变形、骨折移位或断端分离。两组骨折愈合时间比较差异有统计学意义（t=-2.439，P=0.021）。末次随访时，根据Crawford评定标准，对照组优9例、良4例、可2例、差1例，优良率为81.25%；改良组优10例、良3例、可2例，优良率为86.67%；两组比较差异无统计学意义（Z=-0.636，P=0.525）。.
UNASSIGNED: 与经典石黑法相比，改良加压石黑法对骨折间能起到持续弹性加压作用，促进骨折愈合，减少术后克氏针变形及松动，降低手术失败率，减少术后创伤性关节炎等并发症的发生，可有效治疗骨性锤状指。.