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Hook Plate Fixation for Mallet Fractures, prospective study.
Waleed Riad Saleh, Assistant professor, Assiut University, Assiut, Egypt

Introduction:
Mallet fracture is avulsion fractures of the distal phalanx. It results from axial Loading or Forceful flexion of extended digit. Inadequate treatment resulted in Extension lag, Significant swan neck deformity and early osteoarthritic changes. Surgery is indicated in Fractures involving > ⅓ of the articular surface, Persistent subluxation of the DIP joint or Failure to achieve fracture reduction. In this study we evaluated results of using hook plate in treating 17 cases of mallet fracture.
Materials and Methods:
Prospective study Included 17 patients with mallet fracture. Surgery is performed under Local digital block. Hook plate osteo-synthesis is being fashioned from titanium national mini-plate. The hook plate is positioned over the fragment and underneath the periostium and secured with a single screw drilled just distal to fracture site.
Results:
Mean age at surgery was 32.3 years (range 18-50). Mean Operative time 37 minutes (25-45). All fractures were united by 6 weeks PO. Hospital Stay n 8.5 hours (range6-14). Average active range of flexion of the DIP: 50° (range 20°-70°). Extension lag in 4 out of the 17 cases (23.5%).
Conclusions:
This technique provides Anatomic reduction, Rigid internal fixation and early joint mobilization. some reported problems such as Difficulty in fixation, Skin problems, Bulky implant, and need for future implant removal.


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