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• W2161653204 abstract "In his report1Leinberry C. Mallet finger injuries.J Hand Surg. 2009; 34A: 1715-1717Google Scholar, Dr. Leinberry confirms that “the majority of mallet injuries” are best treated with splints. The term mallet finger injuries includes 4 different entities. They are either tendinous, bony with small fragment, or bony with big fragment involving more than one-third of the articular surface, and these are either with or without subluxation of the distal phalanx. No doubt there is general agreement that the first two entities are best treated with splints or with internal splinting with K-wires in selected cases, depending on patients' needs. Attention should be directed to the remaining open question: the correct treatment of bony mallet injuries involving more than one third of the articular surface. As a base of treatment discussion, the differentiation must be made between the bony mallet finger injuries involving more than one third of the joint surface with and without initial subluxation. The indication for surgical treatment remains unclear for both of these injuries, such as “surgery is considered” or “hand surgeons believe… .” Where is the evidence? We have published a small, consecutive series of 10 cases with big bony mallet injuries involving more than one third of the joint surface, with diastasis and fragment dislocation, but with no initial subluxation.2Weber P. Segmüller H. Non-surgical treatment of mallet finger fractures involving more than one third of the joint surface: 10 cases.Handchir Mikrochir Plast Chir. 2008; 40: 145-148Crossref PubMed Scopus (23) Google Scholar They were all treated with 4 to 6 weeks of splinting with perfect radiological (excellent remodelling of the joint surface) and clinical results (near normal flexion at the distal interphalangeal joint and lag of less than 5°) and no secondary subluxation. Our article shows the initial and final radiographs of all 10 cases. Currently, a publication of 35 consecutive cases is being prepared. I think it is time to reconsider the “belief” that the big bony mallet fractures involving more than one third of the articular surface inevitably end in a subluxation of the distal phalanx if surgery is not performed. Surgical stabilization of these fractures without initial subluxation rarely succeeds in anatomic reconstruction of the joint surface, so generally, the leading argument for surgical treatment is the prevention of subluxation. To my knowledge, there is no evidence at all confirming this concept. The only big bony mallet fractures ending in subluxation are the non-treated ones, not the correctly splinted fractures. It also should be mentioned that most big bony mallet finger injuries do not present with an initial subluxation, even if seen with a delay of treatment of several days. Again, the fact that even the splinted fractures with initial slight subluxation do clinically well must be discussed separately. Finally, I wonder about the presented case of a colleague who had 2 distal interphalangeal joints with big bony mallet fractures pinned for 8 weeks and who is now “working on regaining range of motion.” Eight weeks is far beyond what a finger fracture needs to heal, and stiffness problems are to be expected. Unfortunately, in this review, the author does not refer to the length of immobilization with splints or pinning with any of the discussed mallet injuries. Mallet Finger InjuriesJournal of Hand SurgeryVol. 34Issue 9PreviewA 37-year-old orthopedic surgeon was attending a conference. During an afternoon skiing session, he fell and injured his left, nondominant hand long and ring fingers. When he returned to the evening didactic session, an image intensifier identified bony mallet injuries to the long and ring fingers. The long finger showed a bony mallet fracture involving approximately 33% of the articular surface of the distal phalanx with slight subluxation, and the ring finger involved 25% of the joint surface with no subluxation. Full-Text PDF In ReplyJournal of Hand SurgeryVol. 35Issue 4PreviewI wish to thank the author of this letter to the editor for her insightful comments. The review of the literature, as well as this author, shows that there is a need for better randomized, prospective studies to separate the various types of mallet injuries and their treatments. Full-Text PDF" @default.
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• W2161653204 date "2010-04-01" @default.
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• W2161653204 title "Mallet Finger Injuries" @default.
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• W2161653204 doi "https://doi.org/10.1016/j.jhsa.2010.01.017" @default.
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