Open accurate reduction for irreducible mallet fracture through a novel pulp traction technique with primary tendon repair

Abstract

Sixteen patients with bony mallet fingers were treated by a new technique of open reduction through a T-shaped dorsal incision and oblique wire fixation via pulp traction with additional primary extensor repair. Surgical indications included fractures with intra-articular involvement over 1/3 of the articular surface, distal phalanx subluxation and displacement greater than 3mm, irreducible by extension block pinning. The cases were analyzed prospectively for a mean follow up period of 12 months. The results were evaluated using Crawford’s criteria. Eleven cases were evaluated as excellent, 3 cases as good and 2 cases as fair. Complications included 3 cases with transient nail deformity, 2 cases with flexion limitation of 5 degrees and 10 degrees, and three cases with extension lag between 5 to 10 degrees. This novel method of accurate reduction achieves good clinical outcomes with comparatively less complications in mallet fractures irreducible to closed extension block reduction.