Surgical Management of Delayed Mallet Finger Fractures Using Combined Two-Extension Block Kirschner Wire and Dorsal Counterforce Techniques.

Abstract

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. 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. 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. 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. Therapeutic IV.