| Tendinous mallet fingers are best treated with a splint. However, patients who have failed conservative treatments may need surgical intervention. Although various techniques have been proposed, the management remains controversial.Mallet fingers to that finger tendon and extensor tendon check point because of the sudden violence injury, such as the life and work of accident(play, extrusion, violent impact), buckling and finger small fracture happened because of the flexor muscle strength is greater than the extensor muscle strength and power imbalance caused by flexion and extension, distal finger flexion deformity of the interphalangeal joint.With extended time, deformity will gradually increase, causing suffering from pain and restricted movement function and inconvenience. The maximum recovery of finger function and pain relief. Is the main purpose of the study. Surgeons may attempt tendon reinsertion but may fail owing to a gap between the tendon and bone, even with assistance of tendon release and hyper- extending the distal interphalangeal(DIP) joint. Levante et a1 sutured the tendon end to the scar tissues surrounding the base of distal phalanx. Even in patients with successful reattachment, tendon-to-bone healing between the nonhomogeneous tissues is a slower and less reliable process compared with healing within homogeneous tissues(ie, tendon-to-tendon and bone-to-bone). Therefore, mallet deformity may recur as a result of any of the reasons mentioned above.The objective of this study was to describe a surgical technique for the treatment of a tendinous mallet ?nger after failed splinting with a residual extension lag greater than 25°. We reconstructed the tendon-to-bone insertion using a tendonebone graft taken from the extensor carpi radialis brevis(ECRB) and the base of the third metacarpal.ObjectiveTo describe and assess a surgical technique for the treatment of tendinous mallet fingers after failed conservative treatment.MethodsFrom 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 Shoulder, Arm, and Hand questionnaire. Patients reported on their satisfaction based on the Michigan Hand Outcomes Questionnaire.Preoperatively, average ?exion of the injured DIP !joints was 56(range, 51!to 63!) and bsolute extensor loss(compared with the opposite hand) was !37(standard deviation, 8!).Residual extension lag !was 34(standard deviation, 5!). All digits had poor results based on the Crawford criteria. Preoperative compensatory swan neck deformity was observed in 4 ?ngers. The average preoperative DASH score was 3(range, 0e7). Based on the Michigan Hand Outcomes Questionnaire, 2 patients were strongly dissatis?ed with the appearance of the hand, 19 were somewhat dissatis?ed, and 7 were neither satis?ed nor dissatis?ed.ResultsBone 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 ?exion of the injured DIP joints was 65!(range, 57 to 75!), and the measurement on the opposite side was 71!(range, 62 to 76). We noted no hyperextension of the DIP joint. Absolute extensor loss of the DIP joints was 6(standard deviation, 4).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 Shoulder, Arm, and Hand scores averaged 1(range, 0-3)., and 27 patients were satisfied with appearance of the hand. One patient sometimes felt uncomfortable regarding the appearance.ConclusionA tendon-bone graft is a useful and reliable technique for the treatment of tendinous mallet fingers after failed splinting.Many studies show that bony mallet ?ngers yield superior results to tendinous mallet ?ngers, because bone-to-bone healing is more reliable than tendon-to-bone healing.Our technique is an alternative for the treatment of tendinous mallet ?ngers. By converting tendon-to-bone healing to bone-to-bone and tendon-to-tendon healing, we obtained a more stable and normal tendon-to-bone insertion.The technique is reliable and useful with minimal donor site morbidity.The indication for the use of our technique is tendinous mallet ?ngers with failed trials of nonsurgical treatments. We selected patients based on residual extension lag rather than absolute extension lag, because the former refers functional results, and there is no need to restore digital hyperextension.Advantages include creating a normal extensor tendon insertion, which may be associated with better results. |
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