Arch Hand Microsurg.  2023 Jun;28(2):93-96. 10.12790/ahm.23.0009.

Extension block pinning combined with traction using towel clamps for effective reduction of mallet fracture: a technical tip

• Seo I
• Lee KS
• Chung S
• Son SW
• Lee HJ

• KMID: 2542559
• DOI: http://doi.org/10.12790/ahm.23.0009

Abstract

Purpose
Although closed reduction and extension block pinning have been widely used for acute mallet finger fracture, the problem of reduction remains a concern. We describe a tip for the reduction technique using a towel clamp, which provides a longitudinal traction force to the distal phalanx, and report the results of the technique.
Methods
The medical records of 14 consecutive cases from 12 patients with acute mallet fractures were retrospectively reviewed. Reduction was achieved using the towel clamp reduction technique. The radiologic results were evaluated by simple radiographs, the functional results were analyzed in terms of range of motion, and remaining pain was assessed using Crawford criteria.
Results
The mean follow-up period was 8.4 months. The mean union duration was 6 weeks. The mean range of motion was 73°. Eight cases had excellent outcomes, one had good outcomes, four had fair outcomes, and one had poor outcomes. One case of superficial infection and one case of skin necrosis developed, and three cases showed arthritic changes in the distal interphalangeal joint.
Conclusion
The towel clamp technique can provide good reduction during surgery, with favorable radiologic and clinical results.

Keyword

Fingers; Mallet fracture; Reduction; Traction; Towel clamps

Figure

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  Fig. 1. Reduction using hyperextension after extension block wire insertion. The gap is not properly reduced.

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  Fig. 2. Longitudinal traction of the distal phalanx with a towel clamp.

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  Fig. 3. While maintaining longitudinal traction using a towel clamp, the distal interphalangeal joint is extended. A fluoroscopic image shows reduction of the fracture.

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  Fig. 4. A 17-year-old patient presenting with mallet finger fracture with a large proximal bone fragment and subluxation of the distal phalanx (Wehbe and Schneider type IIB). Comparison of plain radiographs: preoperative (A), postoperative (B), and after pin removal (C).

Reference

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