The Journal of hand surgery · 2026
Surgical Management of Delayed Mallet Finger Fractures Using Combined Two-Extension Block Kirschner Wire and Dorsal Counterforce Techniques.
СтатьяНазвание и аннотация: Перевод в очереди
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Lee Seung Hoo, Kim Min Bom, Lee Young Ho
Аннотация
PURPOSE: This study assessed the efficacy of combining the "two-extension block Kirschner wire (K-wire) technique" and "dorsal counterforce technique" for treating delayed bony mallet fractures (≥4 weeks), previously introduced to prevent fracture fragment rotation in axial and sagittal planes in acute cases.
METHODS: Twenty-nine patients with delayed bony mallet fractures were treated using percutaneous curettage, which was performed with a K-wire to debride fibrous tissue from the dorsal fracture gap to the articular side, followed by the two-extension block K-wire technique, incorporating the dorsal counterforce technique for cases of inadequate reduction. If a satisfactory reduction could not be achieved, an open procedure was performed. Outcomes were evaluated over a 6-month postoperative period, focusing on healing time, range of motion, complications, and Crawford functional outcomes.
RESULTS: Of the 29 patients with delayed bony mallet fractures, 13 were treated using percutaneous curettage combined with the two-extension block K-wire technique, and 15 required additional dorsal counterforce technique. One patient required conversion to an open procedure due to failure to restore a congruent joint surface and was excluded from the outcome assessment. All 28 fractures treated using our suggested method healed within 8 weeks, with 24 patients (85.7%) achieving healing within 6 weeks. According to Crawford's evaluation system, the outcomes were excellent, good, fair, and poor in 19, 6, 1, and 2 patients, respectively.
CONCLUSION: Two-extension block K-wire technique combined with the dorsal counterforce technique appears to be a feasible option for delayed bony mallet fractures, achieving a congruent joint surface and satisfactory outcomes in most cases.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
METHODS: Twenty-nine patients with delayed bony mallet fractures were treated using percutaneous curettage, which was performed with a K-wire to debride fibrous tissue from the dorsal fracture gap to the articular side, followed by the two-extension block K-wire technique, incorporating the dorsal counterforce technique for cases of inadequate reduction. If a satisfactory reduction could not be achieved, an open procedure was performed. Outcomes were evaluated over a 6-month postoperative period, focusing on healing time, range of motion, complications, and Crawford functional outcomes.
RESULTS: Of the 29 patients with delayed bony mallet fractures, 13 were treated using percutaneous curettage combined with the two-extension block K-wire technique, and 15 required additional dorsal counterforce technique. One patient required conversion to an open procedure due to failure to restore a congruent joint surface and was excluded from the outcome assessment. All 28 fractures treated using our suggested method healed within 8 weeks, with 24 patients (85.7%) achieving healing within 6 weeks. According to Crawford's evaluation system, the outcomes were excellent, good, fair, and poor in 19, 6, 1, and 2 patients, respectively.
CONCLUSION: Two-extension block K-wire technique combined with the dorsal counterforce technique appears to be a feasible option for delayed bony mallet fractures, achieving a congruent joint surface and satisfactory outcomes in most cases.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.