Pull-in suture technique for the treatment of mallet finger.
BACKGROUND
Mallet finger deformity is a common disability that causes discomfort and inconvenience to the patient. Although numerous operative techniques have been described, surgical management remains controversial.


METHODS
Between 2002 and 2004, 19 patients with an unsuccessful splinting regimen history, chronic deformities of tendinous origin (>3 months after the injury), or fractures involving 30 percent or more of the articular surface underwent surgical treatment. In 11 patients, chronic mallet finger deformity with tendinous origin was present, whereas eight patients presented with mallet fractures involving more than 30 percent of the articular surface. Open reduction with internal "pull-in" sutures and distal interphalangeal joint immobilization with Kirschner wire was accomplished. Active motions of the proximal interphalangeal and metacarpophalangeal joints were not restricted. After removal of the Kirschner wire at week 6, active flexion exercises were commenced immediately, and daily activities were not restricted. Full activity was allowed at day 7. Goniometric measurements, radiographs, and patient satisfaction were evaluated during the follow-up period.


RESULTS
The mean follow-up period of the patients was 16 months (range, 4 to 28 months). Mean extensor lag of the distal interphalangeal joint was 2 degrees (range, 0 to 6 degrees). The mean flexion of the distal interphalangeal joint was 74 degrees (range, 60 to 90 degrees). According to Crawford's evaluation criteria, 14 excellent and five good results were obtained. Apart from radiologically documented mild degenerative changes or joint narrowing in six patients, no complication was encountered.


CONCLUSIONS
The pull-in technique allows accurate realignment of the tendon-bone unit without any specific instrumentation or intraoperative fluoroscopic imaging methods.
Ulusoy
M Gürhan
MG
Ankara, Turkey From the Department of Plastic and Reconstructive Surgery, Ankara Training and Research Hospital, and Department of Orthopedic Surgery, Konya Selçuk University.
Karalezli
Nazm
N
Koçer
Ugur
U
Uysal
Afsin
A
Karaaslan
Onder
O
Kankaya
Yüksel
Y
Aslan
Cafer
C
D000293:Adolescent; D000328:Adult; D001864:Bone Wires; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000473:pathology / Q000601:surgery*; D006227:Hand Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D006230:Hand Injuries / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013536:Suture Techniques; D013708:Tendon Injuries; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome