Search Results (3)

Background and Clinical Significance: Mallet finger is a common injury of the extensor mechanism at the distal interphalangeal (DIP) joint; however, open double mallet lesions are rare and may present a complex reconstruction challenge. Case Presentation: A 15-year-old male high school student who sustained an open injury to the left ring and little fingers after a high-energy buggy accident. The ring finger showed an open double mallet lesion in which the extensor tendon remained attached to a tiny avulsion fragment, and a separate dorsal base fragment was also present. The adjacent little finger had a concomitant open fracture with substantial soft tissue injury. Emergency surgery was performed on the day of the injury. For the ring finger, reduction of the tendon-attached avulsion fragment and separate dorsal base fragment was achieved using extension-block pinning, transarticular DIP pinning, and pull-out fixation over a volar button. For the little finger, cross-pinning was performed because the distal fragment was too small for stable non-transarticular fixation. Serial radiographs showed maintained alignment and progressive healing. At the final follow-up, 21 months after the injury, residual deformity and limitation of DIP motion remained; however, no infection, major skin complications, or nail deformity were observed. The little finger DIP joint became ankylosed, whereas some residual mobility remained in the ring finger DIP joint. Despite persistent functional limitations, the patient was able to continue school attendance and percussion-related activities. Conclusions: This case highlights that in an open double mallet lesion, disruption of both the tendon-attached fragment and its bony bed should be considered, and stabilization of the base may be useful in selected injury patterns before definitive tendon-side repair. Full article

Introduction: Finger injuries are common in pediatric patients and typically heal well with conservative management. However, rare fracture patterns involving significant displacement and physeal injury, such as the one described in this case, require specialized surgical intervention to ensure proper healing and prevent long-term complications. Case Presentation: A 12-year-old left-hand-dominant female presented with pain, swelling, and deformity at the distal interphalangeal (DIP) joint following hyperextension of the left fifth digit. Initial radiographs revealed a volar displaced intra-articular fracture with physis involvement, confirmed by computed tomography (CT) imaging. Conservative management with closed reduction and splinting failed to achieve adequate alignment. Surgical intervention was performed via a dorsal approach, utilizing ORIF with K-wire fixation to restore joint congruity and ensure anatomic alignment. Outcomes: Postoperative follow-up demonstrated satisfactory healing, maintained reduction, and resolution of pain with no complications. The patient regained functional use of the digit with minimal stiffness, and the growth plate remained uninvolved during the recovery period. Discussion: This case underscores the importance of advanced imaging, early referral, and tailored surgical intervention for rare mallet fractures involving volar displacement and physeal injury. ORIF provided reliable stabilization and optimal outcomes in this complex case. Conclusions: Volar displaced Salter–Harris III fractures of the DIP joint are rare and challenging injuries in pediatric patients. This case highlights the role of ORIF in achieving successful outcomes and emphasizes the importance of precise reduction and stabilization to prevent long-term complications. Full article

Introduction: Tendinous and bony mallets are very different injuries that present with extensor lag at the distal interphalangeal joint. This study aimed to evaluate the differences in outcomes between acute bony and tendinous mallet fingers treated conservatively with splints. Materials and Methods: We retrospectively collected data on patients with acute tendinous or bony mallets who received conservative treatment in our occupational therapy clinic. The patients were examined at an outpatient clinic, where data on pain, extension lag, and loss of flexion were recorded. Outcomes were classified according to the criteria described by Crawford. Results: Data were collected from 133 patients (43 with bony and 90 with tendinous mallets). We found that bony mallet patients were predominantly younger (mean, 36 vs. 46 years), and more likely to be female (60% vs. 34%), than tendinous mallet patients. We also found that tendinous mallet injuries predominantly affected the middle and ring fingers, while bony mallet injuries predominantly affected the ring and little fingers. The initial extensor lag was worse in tendinous than in bony mallets (median, 28° vs. 15°). In addition, patients with bony mallets had significantly better outcomes with regard to the extension lag (median 0° vs. 5° p = 0.003) and the Crawford Criteria Assessment (p = 0.004), compared with those with tendinous mallets. Discussion: Mallet injuries, both tendinous and bony, are common. They are often studied together and typically treated in the same manner using extension splints. However, evidence clearly shows that these are different injuries which present in the same manner. This study reinforces these findings and suggests that the outcome of conservative treatment is better for bony than for tendinous mallet fingers. Full article