Repairing Chronic Tendinous Mallet Finger by Brachioradialis Tendon-Bone Graft.

Abstract

The management of chronic tendinous mallet finger resulting from extensor tendon insertion rupture presents a considerable challenge. To our knowledge, this study describes a clinical technique using a brachioradialis tendon-bone graft to reconstruct the extensor apparatus. Ten patients who remained unable to actively extend the distal interphalangeal joint despite nonsurgical treatment were included; of these, two demonstrated secondary swan-neck deformities. All patients demonstrated satisfactory passive range of motion in flexion and extension at the distal interphalangeal joint. Preoperative x-ray revealed no fractures involving the base of the distal phalanx. All surgeries took place between 3 months and 14 years after the initial injury. During the procedure, we inserted the graft's bone block into a prepared bone groove at the base of the distal phalanx and sutured the harvested brachioradialis tendon to the ruptured stump of the extensor tendon. This technique transforms the healing process at the extensor tendon insertion from tendon-bone healing to bone-bone healing. The follow-up period ranged from 3 to 5 years. We assessed postoperative finger function using the Crawford criteria, rating four cases as excellent and six as good. We evaluated overall patient satisfaction using a Likert scale, with scores of 5 in 2 cases, 4 in 6 cases, and 3 in 2 cases. The mean active range of motion was 82°, ranging from 75° to 90°. Only one patient experienced a complication, a slight dorsal protuberance at the distal phalanx. This technique is viable for reconstructing chronic tendinous mallet finger caused by extensor tendon insertion rupture. Therapeutic IV.