Mini-Open Reduction and Extension Block Pinning for Irreducible Mallet Fractures: A Minimally Invasive Technique for Anatomical Reduction

Abstract

Background: Dorsal rotation or persistent displacement of the fracture fragment is frequently encountered in extension block pinning for mallet fractures. We reviewed nine irreducible mallet fracture patients treated with mini-open reduction and extension block pinning. Methods: A small V-shaped incision was made on the fracture gap when there was persistent displacement of fracture fragment despite closed maneuvers and percutaneous procedures while performing extension block pinning. Soft tissue or granulation tissue hampering reduction was removed through the incision. Anatomical reduction was guided with a freer elevator. The incision was closed by distal interphalangeal joint transfixation in extension without any suture. Pin tips were buried under the skin. The incision and pin entry sites were covered with skin adhesive, and the patients were allowed to wash their hands 1–2 days after the surgery. No splint was applied postoperatively. Mean follow-up period was 13 months. Results: Anatomical reduction was achieved in 7 out of 9 patients. In the rest 2 patients, postoperative step-off of the articular surface at the fracture site was less than 0.5 mm. Solid union was achieved in all cases. The mean extension lag at final follow-up was 0°. No patient developed postoperative external bleeding or other complications in the incision site or the pin site. Conclusions: Mini-open reduction and extension block pinning appears to be a good option for irreducible mallet fractures, which improves reduction quality and patients’ convenience.