THE RESULTS OF TREATMENT W. A. T. Senior Mallet finger is the attachment to the caused by avulsion and the the power proximal mechanism The EDINBURGH, Registrar, deformity base of the of a small Royal caused terminal triangular of active extension interphalangeal joint of this joint. method of treatment seen within hyperextension impression ROBB, OF by of Edinburgh a tear of the Sometimes of bone. extensor expansion there is an The terminal from associated phalanx its fracture is flexed is lost, and there may be a secondary hyperextension of due to the exertion of the full power of the extensor generally recommended for a mallet finger, a few days of injury, is immobilisation by a plaster of the distal joint and flexion of the proximal joint created is that the immediate results of this treatment Watson-Jones FINGER SCOTLAND Infirmary phalanx. fragment MALLET particularly if it is splint in the position of for four to six weeks. The are good (Smillie 1937, 1940). The present review was carried out to assess the long-term particular to determine whether or not freedom from disability and were achieved. results of treatment, and restoration offull movement in MATERIAL Seventy-five the Royal shortest patients Infirmary time that with mallet finger treated in the surgical out-patient department of Edinburgh during the years 1952, 1953 and 1954 were had elapsed between the injury and the follow-up examination of reviewed. The was one year. ETIOLOGY The more and in than index fingers general this was found women. The ring with agreement injuries The in the and cases, other fifth little and reported the sixth were thumb series and accidents alleged common and fingers in only and in one especially such men fifty were cases, case. 1930, Smillie (Mason in the home, cause-sports, decades, injured These 1937, middle findings Ratliff during bed-making, as cricket-was not affected the are 1947). accounted encountered series. In thirty time incidence in twenty-four Industrial most cases. for in highest often the of the patient was seventy-five first cases there METHOD Sixty-nine patients extension of the of those cases, four weeks. too tight, plaster come to hospital. Two patients radiological by showed OF evidence of a fracture at the immobilisation joint that TREATMENT and in only flexion thirty had In the others a change of splint too loose, or had become soft off and had treated interphalangeal however, for at least had become had were distal was seen. had not no treatment been and replaced, four plaster of the in the position proximal a satisfactory joint. plaster of An been hyperanalysis maintained had been required because the plaster through getting wet. Sometimes the usually had in because operative repair were recorded the patient of the had ruptured not reported tendon. RESULTS Subjective-Any patient 546 was complaints specifically asked made by the about discomfort patients or any interference THE JOURNAL and, with OF in particular, normal BONE AND each activities. JOINT SURGERY THE One patient in the tended to knock immobilisation Five was of her complained striking of especially improvement Objective-The great joint was individual variation. with the compared or patient (Table extension was was months from expressed as a distal percentage of OF Active Full perfect anatomical deformity was restriction ofactive still immobilisation time than reached. injury. This was . . interphalangeal from of symptomatic this freedom The usual joint was from course found to movement of the affected side and any limitation of normal range for that individual 50 per movement, twenty-eight hyperextension had after stiff for been removal for a few 660 6 85 2 30 per at least than a quarter and cent) the had a full those weeks had reasons which the been and specifically in which carried out, been considered recurred. noted. uninterrupted and above. deformity some movement. those Indeed, in many satisfactory Over the deformity slowly but steadily decreased until the final state No further improvement was ever noted after six months from also proved true for those patients who had unsatisfactory splints individuals who had no treatment. Early treatment-There was no difference treatment within three days of the injury a severe with ofpassive were cases total, patients range described had mallet of the fifty-five factors between the then Of following four for of a plaster days 47 a tenth. inefficient cent 225 in less (51 Per 16 cent obtained was (71 CASES) of cases . in approximately that stated . of the results of treatment the was no significant difference in thereafter was absence fact that of treatment. of injury. TREATMENT Number . per cent result immobilisation finger movement present In the analysis !mmobilisation-There patients terminal pain I AFTER per cent 50-75 Less MOVEMENT range 75-100 affected the I). RANGE which of constant the the constantly by uninterrupted region severe the complete considerable as she treated the reason active and passive joint of the opposite TABLE A been had elicited the end the time caused inasmuch had One questioning sequel to at a normal power in weather. of examination For this corresponding of discomfort cold several lack She 547 FINGER activities on things.” six weeks. occasional of movement MALLET household However, immediate over range flexion and during in all but the above. was not generally an show deformity ordinary the joint. finding at the time in a slow OF persistent course joint, The TREATMENT “ patients osteoarthritis OF her finger and it caught of the finger in plaster for interphalangeal disability trouble that stated inconvenience RESULTS the a variable of recovery the time of and for the two been delayed Fracture-The of persistent five patients for up to three weeks. presence of an associated deformity, but did increase who Operation-Of complained there was distal VOL. complained the and of discomfort patients who NO. 3, joint. AUGUST 1959 ultimate those outcome in whom between the fracture in thirty cases the liability to subjective had had of discomfort. Only one had an average restriction of extension interphalangeal 41 B, four in the sustained operative start did patients of the not affect complaints. who treatment had had the incidence Four of the a fracture. repair a perfect anatomical by 20 degrees and of the result: of flexion ruptured tendon one in the other by 10 degrees three at the 548 W. Complications of treatment-Ten A. T. ROBB patients had pressure sores, eight of which were over the the distal interphalangeal joint, and the scarring associated with healing had caused some limitation of flexion. Since the completion of this follow-up, one patient has been seen in whom too tight a plaster had caused gangrene ofthe terminal phalanx, necessitating dorsal aspect of partial amputation of the finger. DISCUSSION The flexion extensor principle of treatment of the proximal joint fixes the aponeurosis to be approximated Many types of splint method is the I) Application-The (1947), (1947) for immobilisation mallet may observations of the recurs. Duncan extended joint half of some the the and with flexion other writers that patients Mason the noted fingers a Kirschner recommended is based the on the of the plaster results conservative maintain of the efficient was on invariably a fully in approximately have position ruptured of deformity internal are not always satisfactory. The range of movement is uncommon. of the removal the treatment desired had period it be confirms cases advised the repair an thus recurred (1952) use: Howie to have that there early operative shows in many deformity of its immobilisation and It that Pratt popular with (1944), of plaster 1952). but most considered considerable the flexion to the that of the of plaster during the joint-even though difficulties Pratt fact bands of fitting were hours wire but difficulty patients are operation. early position, Any change interphalangeal joint removal poor The results of operative repair good but the restoration of a full often given. distal 1950, on by the be satisfactory forty-eight The this indicate half middle may immediate finger two problems associated by Smillie (1937), Bunnell of treatment. the mechanical the out are than already of the that within carry (1930) less (Rosenzweig treated. to of of maintain (1956) series results (1948) but to There described Watson-Jones the principle indicates that immediate surgeons joints devised the reasons allow flexion upsets review finger plaster been this plaster momentary-and The present the and 2) Maintenance-In a satisfactory a have of a mallet middle slip and allows the two lateral to the site of their distal attachment. application of a plaster. different techniques Williams plaster. of by hyperextension caused fixation for six of weeks, extensor expansion. cosmetic In fact, effect may movement be is less than after conservative treatment : in particular, be restricted by scarring on the dorsal aspect, joint flexion of the distal interphalangeal as was noted in three of our four (1950) also considered that the results may patients who of operative The were treated repair assessment unnecessary. by operation. of the late Improvement proceed, incomplete and, although extension, with of that the Rosenzweig in practically Rosenzweig “ left a lot to be desired.” all cases results occurs lengthening subjective (1950), of mallet in this gradually series as of the tendon end results are and finger suggests healing that and is responsible good. This operative of repair fibrous that a satisfactory if no treatment is given. state The with adhesive strapping or a straight spatula splint may be applied the fingers to relieve the initial discomfort associated with the injury. which is easy to apply, comfortable for the patient and devoid of the now being used in this department. of recovery finger may is tissue for a high incidence assessment is in agreement suggests even early contraction of will occur be strapped to the palmar aspect This form of treatment, of risk is of pressure sores, CONCLUSIONS I. The the position method interphalangeal of of treatment of a mallet hyperextension joint is, on of the the whole, it may need to be changed frequently, 2. In many cases the deformity is still but gradual improvement from finger distal deformity by immobilisation interphalangeal unsatisfactory it is present and the contraction joint because sometimes after and the in a plaster flexion splint of the is difficult in proximal to apply, by pressure sores. of adequate immobilisation, complicated six weeks of fibrous tissue occurs for up to six months. THE JOURNAL OF BONE AND JOINT SURGERY THE Therefore after 3. an assessment an interval The has only end efficient rarely of of at least subjective been results sufficient of patients show slight uninfluenced appreciably 4. The only treatment strapping or at the in to cause persistent by the a OF TREATMENT the results six months. immobilisation is this adhesive RESULTS of end any for straight spatula of six months hyperextension. with 549 FINGER treatment are should satisfactory patients normal in order to relieve made only or not there disability any activities. the be whether have limitation of movement, of treatment. of mallet finger is the cases splint of Few interference most MALLET method deformity and type or duration necessary OF A high and this is seemingly application initial and proportion of elastic discomfort from the injury. REFERENCES 5. (1944): BUNNELL, J. MCK. DUNCAN, H0wIE, Journal, H. 46, Surgery (1948): (1947): The of the Hand. Philadelphia, London, of the Hand. British Journal Treatment of Mallet Finger. A Modified Trauma Montreal: J. B. Lippincott of Surgery, 35, 397. Plaster Technique. New Company. Zealand Medical 513. M. L. (1930): Rupture of Tendons of the Hand. Surgery, Gynecology and Obstetrics, 50, 611. D. R. (1952): Internal Splint for Closed and Open Treatment of Injuries of the Extensor Tendon Distal Joint of the Finger. Journal of Bone and Joint Surgery, 34-A, 785. RATLIFF, A. H. C. (1947):” Mallet “Finger. A Review of 45 Cases. Manchester Medical School Gazette, ROSENZWEIG, N. (1950): Management of the Mallet Finger. South African Medical Journal, 24, 831. SMILLIE, I. S. (1937): Mallet Finger. British Journal of Surgery, 24, 439. WATSON-JONES, R. (1940): Fractures and Other Bone and Joint Injuries. Edinburgh: E. & S. Livingstone. WATSON-JONES, Sir R. (1956): Fractures and Joint Injuries. Fourth edition, Vol. 2, p. 645. Edinburgh London: E. & S. Livingstone Ltd. WILLIAMS, E. G. (1947): Treatment of Mallet Finger. Canadian Medical Association Journal, 57, 582. MASON, PRATT, VOL. 41 B, NO. 3, AUGUST 1959 at the 26,4. and
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