title: Tendon-bone graft for tendinous mallet fingers following failed splinting.
abstract: OBJECTIVE
  To describe and assess a surgical technique for the treatment of tendinous mallet fingers after failed conservative treatment.
  
  
  METHODS
  From January 2010 to March 2012, 28 tendinous mallet fingers in 28 patients were treated. All patients had greater than 25° extensor lags after 6 to 8 weeks of splinting. Four patients had a second trial of splinting, which also failed. A tendon-bone graft, taken from the extensor carpi radialis brevis and the third metacarpal base, was used for reconstruction. The mean time between the injury and operation was 74 days. The mean preoperative extension lag was 34°. Five patients reported pain in the distal interphalangeal joint. At the final follow-up, patients rated the level of pain on the distal interphalangeal and wrist joints using a visual analog scale. Joint motion was graded with the Crawford criteria. Hand function was assessed with the Disabilities of the Arm, Shoulder, and Hand questionnaire. Patients reported on their satisfaction based on the Michigan Hand Outcomes Questionnaire.
  
  
  RESULTS
  Bone healing was achieved in all patients at a mean of 5 weeks. Position of bone graft was maintained until bone healing was evident in all cases. At the mean follow-up period of 15 months, nail deformity was not noted. No patient reported pain on the distal interphalangeal joint or wrist. The mean residual extension lag of the distal interphalangeal joints was 4°. The results showed that 24 digits were excellent and 4 were good based on the Crawford criteria. The Disabilities of the Arm, Shoulder, and Hand scores averaged 1, and 27 patients were satisfied with appearance of the hand. One patient sometimes felt uncomfortable regarding the appearance.
  
  
  CONCLUSIONS
  A tendon-bone graft is a useful and reliable technique for the treatment of tendinous mallet fingers after failed splinting.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Chengde Medical College, Chengde; the Department of Hand Surgery, Second Hospital of Qinhuangdao, Affiliated Hospital of Chengde Medical College, Hebei; the Department of Orthopaedic Surgery, People's Hospital of Lulong, Lulong, Qinhuangdao; the Chinese Medical Association in Qinhuangdao, Qinhuangdao; and the Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: Le
authors.initials: L
authors.lastname: Wang
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.forename: Ze
authors.initials: Z
authors.lastname: Liu
authors.forename: Xiuge
authors.initials: X
authors.lastname: Huang
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhu
authors.forename: Yadong
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005383:Finger Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D006227:Hand Deformities, Acquired / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013165:Splints; D013710:Tendons / Q000601:surgery / Q000637:transplantation*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: Insertion; healing; splinting; tendinous mallet finger; tendon–bone graft