Functional outcome and complications after operative treatment of mallet fingers by the Ishiguro technique

One third of mallet fingers are associated with intra-articular fracture of the distal phalanx. Treatment usually involves splint immobilisation of the distal interphalangeal joint or operative treatment if there is a fracture fragment of more than one third of the articular surface or a palmar subluxation of the distal phalanx. We examined 25 out of 49 consecutive patients treated with the Ishiguro extension block technique in our department to assess the long-term clinical and radiological results. Of the 49 patients with median age of 35 (range 14-74) years, 15 men and 10 women met for a three-year follow up. Scored by Crawford classification we had one excellent, two good, 14 fair and seven poor results. According to relative TAM calculation, we had three excellent, 16 good, five fair and no poor results. The patients reported a median high level of life quality by the Eq-VAS scale, and a median good upper extremity function by the patient-reported outcome QuickDASH, as well as high levels of satisfaction with subjective present hand function and the treatment they received. Despite the small patient sample, we noted two major complications; one case of osteomyelitis and one re-operation due to subluxation, as well as several cases of minor complications. Ten patients had radiological osteoarthritis of at least grade 1 according to the Kellgren and Lawrence grading scale. We question whether operative treatment actually betters the long-term outcome for mallet fractures, and recommend randomised controlled trials comparing conservative splint treatment to extension block pinning in fractures with large fragment