title: Modified tenodesis method for treatment of mallet fractures.
abstract: BACKGROUND
  Mallet fractures are avulsions of the terminal extensor tendon from the base of the distal phalangeal bone with a bony fragment. Surgical treatment, which provides accurate anatomical reduction and rigid fixation, is recommended for mallet fractures with involvement of more than one third of the base of the distal phalangeal bone. Various surgical methods have been reported, but there is still no standard treatment modality. The purpose of this investigation was to assess the results of our modified tenodesis method for mallet fractures.
  
  
  METHODS
  Using our method, the dorsal fracture fragment was reduced and fixed to the main part of the distal phalangeal bone by 2 stitches of "figure-of-eight" 4-0 Prolene sutures. We reviewed 12 consecutive patients with 13 mallet fractures treated with our modified tenodesis method between January 2009 and March 2012. This retrospective study was composed of 7 male and 5 female patients, with a mean age of 35.7 years (range, 25-56 years). All patients underwent surgical treatment and sequent 3-week finger splinting. Patient follow-up lasted 3 to 6 months, with a mean period of 5.2 months.
  
  
  RESULTS
  The modified tenodesis method allowed accurate anatomical reconstruction of the injured extensor mechanism. Grading by Crawford criteria showed that the outcome was "excellent" in 8 of 13 digits and "good" in 5 of 13 digits. The follow-up hand x-rays also revealed congruent joint surfaces of distal interphalangeal joints with no evidence of joint space narrowing. No wound complications were encountered, and all the patients returned to normal activities without any disability.
  
  
  CONCLUSIONS
  The modified tenodesis method is simple and effective to provide accurate anatomical reduction and fixation for treatment of type I mallet fractures. No device penetration of the small bony fragment or pinning through the distal interphalangeal joint is required, and the surgical complication rate is low. We recommend this treatment modality for all but chronic cases.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Kwang-Yi
authors.initials: KY
authors.lastname: Tung
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Tsai
authors.forename: Shih-Hsin
authors.initials: SH
authors.lastname: Chang
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Huang
authors.forename: Hung-Tao
authors.initials: HT
authors.lastname: Hsiao
mesh_terms: D000328:Adult; D003288:Contusions / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005383:Finger Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D050278:Finger Phalanges / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006227:Hand Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013165:Splints; D053656:Tenodesis / Q000379:methods*