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Mallet Fractures: A Novel Approach to Internal Fixation Using A Hook Plate

From the Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore

Correspondence: Dr Lam-Chuan Teoh, Senior Consultant Surgeon and Clinical Associate Professor, Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. Tel.: +65 6321 4588; fax: +65 6321 3573. E-mail:ghswly{at}sgh.com.sg

A new treatment of mallet fractures of the distal phalanx is presented. Open reduction and internal fixation was performed using a "hook" plate fabricated from a 1.3 mm AO hand modular system straight plate. This technique avoids the need to place implants or wires through the small avulsion fragment while still being able to achieve a stable "tension-plate" type of fixation construct strong enough to allow protected early active motion of the distal interphalangeal joint. In minimising the need for prolonged splinting, patient comfort is also improved. In a consecutive series of nine fractures, union was achieved in all cases. At an average follow-up period of 17 months, four had excellent and five had good results using the Crawford rating scale. Using the Warren and Norris scale, all patients had a successful result. The final average active range of flexion of the distal interphalangeal joint was 64° and there was no extensor lag.

Key Words: mallet fracture • mallet finger • distal interphalangeal joint fracture • open reduction internal fixation • tension plate

Journal of Hand Surgery (European Volume), Vol. 32, No. 1, 24-30 (2007)
DOI: 10.1016/j.jhsb.2006.09.007


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