Pull-Out Wire Fixation for Acute Mallet Finger Fractures With K-Wire Stabilization of the Distal Interphalangeal Joint

Purpose The aim of this study was to describe and assess a surgical technique for the treatment of mallet finger fractures using a pull-out wire with K-wire stabilization of the distal interphalangeal (DIP) joint in extension. Methods From May 2003 to January 2008, we performed pull-out wire fixation of the fracture fragment with stabilization of the DIP joint using a K-wire in 65 closed mallet finger fractures in 65 patients with a mean age of 32 years (range, 18-48). The mean time between the injury and surgery was 8 days (range, 0-19 d). In this cohort, the mean joint surface involvement was 39% (range, 30% to 49%) and all injuries were associated with DIP joint subluxation. Fifteen days after surgery, the digits were assessed for skin necrosis, skin breakdown, and wound and wire track infection. Patient follow-up lasted 24 to 27 months, with a mean period of 25.5 months. The fingers were assessed for loss of extension and flexion of the DIP joints. We graded the results using Crawford's criteria. Results Fracture reduction was maintained and all fractures united. We found no skin necrosis, skin breakdown, infection, or nail deformities. At the final follow-up, the mean extensor loss of the DIP joints was 70 (range, 0 to 37). The mean flexion loss of the DIP joints was 1 (range, 0 to 15). We noted extensor loss of the joint less than 10 in 57 digits and 10 to 150 (mean, 13) in 8 digits. Based on Crawford's criteria, 52 digits were excellent, 8 were good, 4 were fair, and one was poor. Conclusions Pull-out wire fixation of the reduced fracture fragment and K-wire stabilization of the DIP joint is a useful technique for the treatment of mallet finger fractures. (J Hand Surg 2010;35A:1864-1869. Copyright (C) 2010 by the American Society for Surgery of the Hand. All rights reserved.)