An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called “mallet toe” of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, ...An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called “mallet toe” of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, percutaneous or open Kirschner wire fixation similar to that in the mallet finger, or suture anchor fixation. We present a case treated by the bridging technique using two suture anchors. A 57-year-old Japanese man injured his left great toe after a fall while walking barefoot on the bed. His great toe was forced into a hyperplantarflexion position. Plain radiography and computed tomography showed a small bone fragment at the base of the dorsal distal phalanx, suggesting an avulsion fracture of the extensor hallucis longus. He was treated by bridging suture technique with two suture anchors. At first, two suture anchors were inserted to the fracture bed of the distal phalanx, and then the bone fragment and extensor hallucis longus tendon were secured with two horizontal mattress sutures. Finally, bridging sutures were performed using the remaining sutures and the sutures used for mattress suturing. He obtained bony union and symmetric range of motion of the interphalangeal joint. This technique allowed us to fix the small bone fragment rigidly and mobilize the interphalangeal joint earlier to preserve the range of motion. It would be a valuable procedure when the bone fragment is small.展开更多
Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fracture...Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fractures,invest电ate a new mallet fracture classification system using anatomical and imaging methods,and discuss the treatment schemes for different types of mallet fracture.Methods:Sixty-four fresh cadaveric fingers were divided into four groups,and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%,50%,75%,and 100% of the bilateral collateral ligaments.The the stability of the distal interphalangeal joint was them observed.The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture,the thickness of fracture,the untreated time after injury,and the complication of distal interphalangeal joint palmar subluxation.Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion,the Ishiguro method,or single Kirschner wire fixation.Results:The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral effect of mallet fractures on was then observed.The lateral radiographs of mallet ligaments were cut off by 25%(t=-0.415,P=0.684)and significantly unstable when this range was≥50%(50% transection:t=-6.363,P<0.001;75% transection:t=-17.036,P<0.001;100%transection:t=-30.977,P<0.001,respectively).The mallet fractures were divided into Types Ⅰ,Ⅱ,and Ⅲ(fracture involving<20%,20%-50%,and>50% of the joint surface,respectively).Type Ⅱ was further divided into Tpes Ⅱa and Ⅱb according to whether the course of injury was<or≥2 weeks,respectively.The mean post-operative flexion of the distal interphalangeal joint was 63.4°±7.9°,and the mean extension lag was 6.7°±4.6°.Conclusions:The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint.Type Ⅱ was further divided into Types Ⅱa and Ⅱb according to whether the course Classification that combines the involvement of the joint surface in the fracture,the thickness of the fracture,and the untreated time after injury is reasonable and will help to choose an appropriate operational method.展开更多
文摘An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called “mallet toe” of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, percutaneous or open Kirschner wire fixation similar to that in the mallet finger, or suture anchor fixation. We present a case treated by the bridging technique using two suture anchors. A 57-year-old Japanese man injured his left great toe after a fall while walking barefoot on the bed. His great toe was forced into a hyperplantarflexion position. Plain radiography and computed tomography showed a small bone fragment at the base of the dorsal distal phalanx, suggesting an avulsion fracture of the extensor hallucis longus. He was treated by bridging suture technique with two suture anchors. At first, two suture anchors were inserted to the fracture bed of the distal phalanx, and then the bone fragment and extensor hallucis longus tendon were secured with two horizontal mattress sutures. Finally, bridging sutures were performed using the remaining sutures and the sutures used for mattress suturing. He obtained bony union and symmetric range of motion of the interphalangeal joint. This technique allowed us to fix the small bone fragment rigidly and mobilize the interphalangeal joint earlier to preserve the range of motion. It would be a valuable procedure when the bone fragment is small.
基金This study was supported by the Beijing Health System Project for High-level Technical Scholars(No.2015-3-036).
文摘Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fractures,invest电ate a new mallet fracture classification system using anatomical and imaging methods,and discuss the treatment schemes for different types of mallet fracture.Methods:Sixty-four fresh cadaveric fingers were divided into four groups,and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%,50%,75%,and 100% of the bilateral collateral ligaments.The the stability of the distal interphalangeal joint was them observed.The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture,the thickness of fracture,the untreated time after injury,and the complication of distal interphalangeal joint palmar subluxation.Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion,the Ishiguro method,or single Kirschner wire fixation.Results:The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral effect of mallet fractures on was then observed.The lateral radiographs of mallet ligaments were cut off by 25%(t=-0.415,P=0.684)and significantly unstable when this range was≥50%(50% transection:t=-6.363,P<0.001;75% transection:t=-17.036,P<0.001;100%transection:t=-30.977,P<0.001,respectively).The mallet fractures were divided into Types Ⅰ,Ⅱ,and Ⅲ(fracture involving<20%,20%-50%,and>50% of the joint surface,respectively).Type Ⅱ was further divided into Tpes Ⅱa and Ⅱb according to whether the course of injury was<or≥2 weeks,respectively.The mean post-operative flexion of the distal interphalangeal joint was 63.4°±7.9°,and the mean extension lag was 6.7°±4.6°.Conclusions:The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint.Type Ⅱ was further divided into Types Ⅱa and Ⅱb according to whether the course Classification that combines the involvement of the joint surface in the fracture,the thickness of the fracture,and the untreated time after injury is reasonable and will help to choose an appropriate operational method.
