Orthopaedic Hand Trauma CH32 (1)

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CHAPTER 32  | Mallet Finger

■ ■ Closed reduction percutaneous pinning (CRPP) versus open reduc- tion internal fixation (ORIF) ● ● CRPP— extension block pinning consists of a Kirschner wire (K-wire) through the extensor tendon dorsally and proximal to the avulsion fragment into the middle phalanx. The DIP joint is then extended, and this K-wire acts as a lever to reduce the avul- sion fragment into the distal phalanx. A transarticular K-wire is then placed in a retrograde fashion through the distal phalanx and into the middle phalanx to prevent DIP joint flexion and loss of reduction ( Figure 32.7 ). ◆ ◆ Complications— short-term stiffness, septic arthritis, improper fracture reduction, and posttraumatic osteoarthritis ◆ ◆ Postoperative care— Routinely the DIP joint is immobilized in extension for 6 to 8 weeks to allow the extensor tendon to heal before K-wire removal in clinic. This is followed by nighttime splinting in extension for an additional 2 to 4 weeks. Formal physiotherapy is often helpful to regain DIP joint range of motion and strength. ● ● ORIF— There are a myriad of different techniques that use K-wires, small screws, hook plates, sutures, tension band, etc. The main ad- vantage of this procedure is the direct access to the extensor tendon. Exposure is routinely made through a dorsal approach overlying the DIP joint.

Figure 32.7  Lateral radiograph utilizing dorsal block and transarticular closed reduction percutaneous pinning techniques.