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American Association for Hand Surgery

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Bony Mallet Finger Injuries in the Pediatric Population: Surgical Treatment and Outcomes
Casey M Codd, BA1, Cameron Amini, BS2, Catherine C May, BS3 and Joshua M Abzug, MD1, (1)University of Maryland School of Medicine, Baltimore, MD, (2)University of Maryland School of Medicine, Timonium, MD, (3)University of Maryland, Timonium, MD

Introduction
Pediatric patients are predisposed to bony mallet finger injuries due to the weaker nature of the physis however there is no consensus regarding treatment within the pediatric population. The purpose of this study was to determine the technique and outcomes of pediatric patients with bony mallet fingers that were managed surgically.
Materials & Methods
A retrospective chart review was performed of pediatric and adolescent patients treated for a bony mallet finger over a 9-year period. Patient demographics, mechanisms of injury, fracture pattern, immobilization type, immobilization length, operative technique, pin size, pin configuration, post-operative immobilization type, post-operative immobilization length, length of follow-up, patient outcomes, and complications were recorded. Simple statistical analysis was performed.
Results
Eight patients had a bony mallet finger that was treated operatively, with an average age of 14.74 years (SD: 2.81; range: 8.38 - 17.51 years). Five of the injuries (63%) were the result of playing either basketball or football, one (13%) was due to a fall onto an outstretched hand, one (13%) occurred following an altercation, and one (13%) was due to the finger being shut in a door. The long finger was the most affected digit (4 injuries, 50%) followed by the ring and small fingers (2 injuries, 25% each). Seven of the patients (87.5%) were treated with extension block pinning utilizing two 0.045" Kirchner wires and one patient (12.5%) was treated with an open reduction internal fixation utilizing one 0.035" Kirchner wire. Patients were immobilized for an average of 31.63 days post-operatively (SD: 3.93; range: 27-38 days) and the pins were removed at the time that immobilization was ceased. Six patients (75%) returned for range of motion checks with four patients (66.7%) having no extensor lag and two patients (33.3%) having a 5-10 degree extensor lag. All patients had flexion of 70-80 degrees. No physeal arrests or other complications occurred in the cohort.
Conclusions
Pediatric bony mallet finger injuries that necessitate surgical intervention can be successfully treated with the extension block pinning technique with a low complication rate expected. Further studies assessing bony mallet finger injuries in the pediatric population, the surgical interventions utilized, and their outcomes are warranted.


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