Extension Block Pinning Versus Hook Plate Fixation for Treatment of Mallet Fractures.
PURPOSE
To compare the outcomes and associated costs of the treatment of mallet fractures with either extension block pinning or open reduction and hook plate fixation.


METHODS
We treated 22 patients for a mallet fracture that involved at least 25% of the distal phalanx articular surface. Three joints demonstrated concomitant volar subluxation. Extension block pinning was used to treat 16 fractures (group 1) and 6 were treated with open reduction and hook plate fixation (group 2). All patients were evaluated at the second, fourth, and sixth weeks after surgery. Collected data included range of motion, extensor lag, and pain status. Patients were asked to grade preoperative and postoperative pain levels on a visual analog scale. Functional outcomes were determined by Crawford criteria. We retrospectively performed a cost analysis using our institutional records.


RESULTS
Mean follow-up was 12.7 months. Visual analog scale pain scores improved by a similar amount for both groups. Preoperative pain scores were 7.0 for group 1 and 7.5 for group 2. Postoperative levels were 2.0 and 2.0, respectively. Mean extensor lag was identical for both groups, 5°. Mean flexion was 70° for group 1 and 80° for group 2. Based on the Crawford criteria, group 1 had 5 patients rated as excellent, 6 as good, 3 as fair, and 2 as poor. Group 2 outcomes were 2 excellent, 2 good, and 2 fair. Five complications occurred in group 1, and 1 in group 2. Differences noted between groups were not statistically significant. Extension block pinning was more cost-effective than hook plate fixation.


CONCLUSIONS
We find extension block pinning to be an equally effective but more cost-efficient treatment than open reduction and hook plate fixation.


TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic III.
['Toker|Serdar|S|', 'Türkmen|Faik|F|', 'Pekince|Oğuzhan|O|', 'Korucu|İsmail|İ|', 'Karalezli|Nazım|N|']
D000293:Adolescent D000328:Adult D001860:Bone Plates D005260:Female D050278:Finger Phalanges D005500:Follow-Up Studies D005593:Fracture Fixation, Internal D050723:Fractures, Bone D006801:Humans D057072:Intra-Articular Fractures D008297:Male D008875:Middle Aged D016059:Range of Motion, Articular D012189:Retrospective Studies D016896:Treatment Outcome D055815:Young Adult
Extension block pinning hook plate mallet fracture