Delta Wiring Technique to Treat Bony Mallet Finger: No Need of Transfixation Pin

Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in mallet fractures with fracture fragment involving more than one-third of the distal phalanx articular surface. The authors are reporting 5 cases of mallet fractures treated with delta wiring technique with good functional and radiologic outcomes. Radiologic outcomes were evaluated on the basis of postoperative and follow-up x-rays and functional outcomes were evaluated using Crawford's criteria. Five patients (4 males, 1 female) with a mean age of 26.8 years (range, 20 to 33 y) were included. The mean time between the injury and surgery was 5 days (range, 3 to 7 d), and the mean follow-up period was 8.6 months (range, 8 to 10 mo). Radiographic bone union was achieved in all patients within an average of 6.4 weeks (range, 6 to 7 wk). At the final follow-up, the distal interphalangeal joint had an average degree of flexion of 73 degrees (range, 70 to 75 degrees) and an average extension deficit of 5.40 (range, 0 to 8 degrees). According to Crawford's criteria, 1 patient had excellent results and 4 patients had good results. No patient reported pain at the final follow-up with a visual analog scale score mean of 0.6 (range, 0 to 2). Satisfactory clinical and radiologic outcomes were obtained with the delta wiring technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.

Mallet Finger Fracture Treated with Delta Wiring Technique: A Case Report of a New Fixation Technique

INTRODUCTION

Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in a case of mallet finger with fracture fragment involving more than one-third of the distal phalanx articular surface. This is the first reported case of mallet fracture treated with delta wiring in literature.

CASE REPORT

A 30-year-old male patient admitted in our institute with complaints of severe pain in the right index finger with inability to extend the distal interphalangeal joint (DIP) for 5 days. There was a history of fall from the bike before this complaint. Radiographs revealed a bony mallet fracture involving more than one-third of the articular surface of distal phalanx. The patient was taken up for delta wiring fixation of the fracture. Radiographic bony union was seen at 7 weeks. At the final follow-up at 1 year, DIP had 75° of flexion and had extension deficit of 5°. According to Crawford's criteria, the patient had good results with a VAS score of 1 with no pain.

CONCLUSION

Delta wiring technique is a new and safe treatment modality for bony mallet fracture with fracture fragment involving more than one-third of the distal phalanx articular surface as satisfactory clinical and radiological outcomes obtained in our case.

Mallet Finger Fracture Treated with Delta Wiring Technique: A Case Report of a New Fixation Technique

Introduction

Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in a case of mallet finger with fracture fragment involving more than one-third of the distal phalanx articular surface. This is the first reported case of mallet fracture treated with delta wiring in literature.

Case Report

A 30-year-old male patient admitted in our institute with complaints of severe pain in the right index finger with inability to extend the distal interphalangeal joint (DIP) for 5 days. There was a history of fall from the bike before this complaint. Radiographs revealed a bony mallet fracture involving more than one-third of the articular surface of distal phalanx. The patient was taken up for delta wiring fixation of the fracture. Radiographic bony union was seen at 7 weeks. At the final follow-up at 1 year, DIP had 75° of flexion and had extension deficit of 5°. According to Crawford's criteria, the patient had good results with a VAS score of 1 with no pain.

Conclusion

Delta wiring technique is a new and safe treatment modality for bony mallet fracture with fracture fragment involving more than one-third of the distal phalanx articular surface as satisfactory clinical and radiological outcomes obtained in our case.

Comparative effects of nondepolarizing muscle relaxants on succinycholine-induced fasciculations and postoperative pain

The effectiveness of pancuronium (1.0 to 1.5 mg), d-tubocurarine (3 mg), and gallamine (20 mg) administered three minutes before succinylcholine (1 mg/kg) in preventing muscle fasciculations and postoperative muscle pains was compared in 100 patients. Pretreatment with pancuronium abolished fasciculations and produced rapid and excellent muscle relaxation for endotracheal intubation. Both d-tubocurarine (dTc) and gallamine administered prior to succinylcholine (SCh) were inconsistent in prevention fasciculations. Muscle relaxation was significantly delayed in onset, shorter in duration, and was inadequate for intubation in the majority of patients. The 45% incidence of postoperative muscle pains in the control group decreased after pretreatment with gallamine, dTc, and pancuronium to 20%, 15%, and less than 5%, respectively. It was concluded from the present study that pancuronium is superior to dTc and gallamine for preventing SCh-induced fasciculations and postoperative muscle pains without compromising the muscle relaxation for intubation. However, pancuronium administered for pretreatment may significantly prolong the action of succinylcholine and caution is to be exercised in patients having short surgical procedures and when additional doses of muscle relaxants may be required.