Korean J Sports Med.  2024 Jun;42(2):113-118. 10.5763/kjsm.2024.42.2.113.

Alternative Technique Using Opencast for Early Return to Play after Operation in Patients with Bony Mallet Finger by Sports Injury: A Retrospective Study in a Tertiary Hospital in South Korea

• Lee KH
• Jung SY
• Kim JW

• KMID: 2556276
• DOI: http://doi.org/10.5763/kjsm.2024.42.2.113

Abstract

Purpose
Bony mallet finger is commonly seen in the young sports population, and surgical intervention is often necessary in cases where the joint surface is compromised. After surgical treatment, compliance with wound management tends to be poor and return to sports activities is delayed, resulting in decreased patient satisfaction. Therefore, the authors suggest that early return to sports can be facilitated through the modified Kirschner wire (K-wire) extension block technique and wound management.
Methods
From March 2022 to February 2023, surgical treatment was performed on 24 patients with bony mallet fingers who had closed fractures with more than one-third involvement of the joint surface or subluxation of the distal interphalangeal joint. Surgeries were conducted within 2 weeks of the injury, employing the K-wire extension block technique. At the first outpatient department follow-up after 1 week, suture knots were removed, medical skin adhesive bonds were applied and an opencast was utilized to fix only distal interphalangeal joint allowing for immediate showering and engagement in physical activities.
Results
All patients expressed satisfaction from both functional and cosmetic perspectives and were able to return to sports activities early. According to Crawford evaluation criteria, the results were as follows: excellent in 68.8%, good in 25.0%, and fair in 6.2%. There were no cases of poor outcomes.
Conclusion
In cases where early return to sports activities is desired, the K-wire extension block technique with burying the K-wires beneath the skin and employing opencast can be an alternative method that can facilitate early return to sports.

Keyword

Bony mallet finger; Extension block technique; Phalanx fracture; Opencast

Figure

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  Fig. 1 (A) Release soft tissue with fracture gap site using Kirschner wire (K-wire). (B) Fix the two K-wires to the dorsal side maintaining the distal interphalangeal (DIP) joint at 90°. (C) Extend the DIP joint, compress the bone fragment using a pin, and then fix the bone fragment using a K-wire. (D) The K-wire is passed through and fixed to the middle phalanx while the DIP joint is extended.

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  Fig. 2 Kirschner wire (K-wire) cutter (empty). (B) K-wire cutter with K-wire.

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  Fig. 3 (A) Initial lateral radiograph. (B) Intraoperative clinical image. (C) Postoperative lateral radiograph. (D) Opencast application at the first outpatient department follow-up after 1 week. (E) Postoperative 6-week lateral radiograph shows radiologic union.

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