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New Method of Mallet Fracture Fixation using a Hook Plate Yields Good Anatomic Alignment and Function
Haritha B. Veeramachaneni, MD; Brad Edgerton; University of Southern California
Kaiser Permanante West Los Angeles, Los Angeles, CA, USA

Introduction: We present our recent experience adopting the use of a new and unique method to fix mallet fractures. Displaced mallet fracture are difficult to correct in a manner that allows for early motion of the DIP joint. This method allows for anatomic stabilization with early ROM.

Methods: A retrospective review over the past 3 years of displaced intra-articular mallet fractures fixed with this technique has yielded 6 cases in 5 patients. The technique involves creating a hook plate out of a 2 hole AO modular 1.3 mm plate. A screw is used in one of the plate holes and the other cut hole is bent and used to stabilize the mallet. The immediate and long term complications, occupational therapy assessments, need for hardware removal, and post-operative return to ADLs were assessed for each patient.

Results: All patients achieved a stable anatomic reduction of the mallet fragment intraoperatively. All patients were followed with x-rays at approximately 2 and 6 weeks after surgery and were found to have bony healing at the fracture site. All patients were pain free. Review of occupational therapy assessments and clinical notes showed that the patients had regained either full ROM or ROM to the goal of 50 degrees. Out of the 6 fingers/cases fixed, one had their plate removed as the hardware was palpable under then thin DIP skin. Two patients had a mild (10-15 Degree) extensor lag. All patients returned to functional ADLs without any issue.

Conclusions:

Although bony mallet fragments which are intra-articular are a difficult problem to fix, we have found success using this unique and novel method. This is the first known series reported since the original paper describing the technique (Teoh et al. JHS 2007) The small plate allows for secure fixation without disrupting the nailbed and is small enough that in most cases does not require future removal.

Fig 1: Intra-operative Exposure and Fixation

Fig 2: Immeadiately after ORIF

Fig 3: 6 weeks after ORIF and K-wire removal


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