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Glendale Adventist Medical Center
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Glendale, CA 91206
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Seems like everything we buy these days at the discount stores is all from China. Are they exporting any better health care ideas than we have here in the U.S.? I could use a little help with a problem I have called mallet fracture.

Even though it sounds like your comment/question is a bit tongue-in-cheek, there is actually a recent report on a new surgical technique for displaced mallet finger fractures. And it comes from the Peoples Republic of China. Mallet finger injuries are common among sports athletes but they can also occur at work and during activities at home. An injury of this kind affects the distal interphalangeal (DIP) joint. That's the anatomical term for the joint that moves the tip of the finger. Baseball players top the list of people at risk for mallet finger injuries. Usually the tip of the finger is hit by a fast moving ball. Fracture of the bone can be accompanied by avulsion -- a piece of bone gets pulled off and away from the bone along with the tendon that attaches to the bone. To be more specific, a mallet finger fracture is an avulsion of the extensor tendon with a piece of bone still attached to it. The damage occurs where the tendon normally attaches to the base of the phalanx (finger bone). What's the best way to treat this problem? That's the subject of this study from China. Hand surgeons there used a special technique called pull-out wire fixation to treat mallet finger fractures in 65 patients. They also used K-wires to help stabilize the fracture site until healing could take place. The reason this surgical technique is different is the combination of the pull-out wire and K-wire. Other surgeons using just one of those techniques often report failed surgeries. With the repair made using just one fixation technique, patients can end up with skin or bone necrosis (death), migration (movement) of pins used to hold the bone pieces together, and loss of reduction. Loss of reduction refers to the fact that the bone fragment that was reattached to the main phalanx moves away again. In this study from China, before surgery was done, each one of the 65 patients was treated conservatively without surgery. They were placed in a splint until bone healing took place. That is the standard of first-line care for mallet finger fractures. But if nonsurgical treatment fails, then surgery is needed to repair the problem. Not all mallet finger fractures need this extra surgical fixation. The authors included only patients who had an avulsed fracture that had shifted or moved more than one-third the distance of the joint surface. There was only one bone fragment and it was displaced at the time of the injury. The good results bear out the value of this pull-out wire fixation technique. Measures used to assess success included complications such as nail deformities, skin breakdown and necrosis, and wound or wire track infections. They had no incidences of any of these potential complications. No one developed additional fractures from the pull exerted on the bone from the treatment. All patients healed with full union between the two pieces of bone. The authors concluded that their proposed combined technique of pull-out wire fixation and K-wire stabilization are just the trick to get an unstable, displaced mallet finger fracture to heal. This surgical technique also preserves the damaged joint and may possibly help prevent osteoarthritis later down the road.


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