Operative Treatment of the Mallet Fracture using a Hook Plate

Aim: The aim of the present investigation was to evaluate the outcome after operative treatment of dorsal distal phalanx fractures near to the base of type Doyle IVb and IVc by means of a hook plate. Patients and Methods: Between February 2002 and September 2009 77 patients were treated by operation by means of 77 hook plates because of a fracture of the dorsal distal phalanx near to the base of type Doyle IVb and IVc. 59 of these patients, 13 women, 46 men, with an average age of 29.3 (13-72) years were followed up for on average 38.3 (3-69) months after operation. At follow-up the range of movement in the distal interphalangeal joint was measured compared to the other hand, nail growth defects were registered and an X-ray examination of the finger was performed. The patients were asked about pain, limitations of function, the satisfaction with the aesthetic result and whether the patients would undergo the same operation once more. The total result was judged by means of a self-made scale of assessment by evaluating the objective and subjective data. Results: Postoperative bleeding, disorders of wound healing and infections were not observed. In 7 patients nail growth defects were found, 3 of which were subjectively very irritating. The material for osteosynthesis was removed 14 times, while the plate had to be removed prematurely due to imminent perforations two times. After a renewed trauma, a dislocation of the fragments was observed. The mean range of movement in the distal interphalangeal joint was amounted to 77 (0-90) degrees, showing a mean deficiency in extension of 7 degrees (0-32 degrees) and a mean deficiency in flexion of 7 degrees (0-40 degrees) compared to the unharmed opposite side. The total result was assessed 51 times (84.7%) as very good, 5 times (8.5%) as good and 4 times (6.8%) as bad. Conclusion: Even if the operation technique is relatively uncomplicated and even in the majority of the cases one can achieve very good or good results in the treatment of the dorsal distal phalanx fractures near to the base, the rate of complication is significant with 7 nail growth defects and two premature removals of the plate due to imminent perforation of the skin. Considering this rate of complication the indication, the operation technique and the implant require verification.