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Technique de l’embrochage percutané d’arthrorise contre orthèse d’extension pour le traitement du mallet-finger osseux aigu : étude rétrospective - 07/04/21

Extension pin block technique versus extension orthosis for acute bony mallet finger; a retrospective comparison

Doi : 10.1016/j.rcot.2020.11.015 
Gurkan Gumussuyu a, Mehmet Melih Asoglu b, Olcay Guler a, Hasan May b, Adil Turan b, Ozkan Kose b,
a Altinbas University, Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey 
b Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey 

Auteur correspondant.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 07 April 2021

Abstract

Purpose

This study aimed to compare the clinical, radiological, aesthetic and economic outcomes of extension pin block technique and extension orthosis in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation (Wehbe and Schneider classification type IB and IC).

Materials and methods

39 patients (11 women and 28 men; mean age: 40.9±11.5 years) who had mallet fractures were retrospectively reviewed. Twenty-one patients were treated with the extension pin block technique, and the remaining 18 were treated with the extension orthosis. Fracture classification, measurement of articular surface involvement, presence of subluxation, and the fragment displacement were performed according to the Wehbe and Schneider classification. Crawford's criteria, extension lag, distal interphalangeal joint (DIPJ) range of motion, dorsal bump, and visual analog scale were evaluated. Fracture union, articular incongruity, and all other complications were followed and analyzed. The Michigan Hand Questionnaire (MHQ) was used to evaluate the aesthetic perception of the patient's finger. Direct and indirect costs were calculated for each treatment method.

Results

At the final follow-up (mean: 18.4±6.2 months), there was no significant difference with respect to clinical outcomes between groups (p=0.335) and pain (p=0.131). Fracture union was achieved in all cases. Both extension lag (p=0.150) and DIPJ flexion (p=.261) were not different between groups. Dorsal bump was more frequent in the conservative treatment group (p=0.048). Aesthetic scores were similar between groups (p=0.477), but female patients rated significantly lower aesthetic scores than males (p=0.003) regardless of the treatment method. The direct medical (p=0.001), indirect (p=0.009) and cumulative costs (p=0.001) were significantly higher in surgical treatment group. One pin tract infection, one nail dystrophy, and one joint space narrowing were seen in the surgical treatment group versus none in the conservative treatment group (p=0.698).

Conclusions

Conservative treatment does not result in inferior clinical, radiographic and aesthetic outcomes compared to surgical fixation in closed mallet fractures with more than 1/3 of articular surface involvement without subluxation. Extension orthosis which is non-invasive, and cheap, maybe the treatment of choice in closed mallet fractures.

Level of evidence

IV; Retrospective cohort.

Le texte complet de cet article est disponible en PDF.

Keywords : Mallet finger, Bony mallet, Extension pin block, Conservative treatment, Extension splinting



 Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.


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