Extension-block pinning versus custom-made plate fixation technique: A comparison of two methods in the treatment of osseous mallet finger injuries.

Background: Mallet finger injuries, characterized by a flexion deformity caused by trauma to the extensor mechanism at the base of the distal phalanx, can lead to significant functional impairment if not treated appropriately. Surgical interventions for osseous mallet finger injuries often include techniques such as extension-block pinning and perioperative modifying plate fixation. When comparing these two methods, it is critical to assess factors such as technical ease, perioperative considerations, and postoperative outcomes. This study aims to compare these two techniques to provide valuable insights into the optimal surgical approach for treating osseous mallet finger injuries, improving patient care and outcomes.

Methods: From 2017 to 2022, a retrospective study of 89 patients with Doyle classification type IVB and IVC mallet finger injuries was conducted. The patients were divided into two groups using a surgical technique called block randomization. Group 1 included 46 patients treated with the extension-block pinning fixation technique, while Group 2 comprised 43 patients treated with the perioperative modifying plate fixation technique. Observations included nail deformities and dorsal prominence at the distal interphalangeal (DIP) joint.

Results: All patients were deemed eligible for surgical intervention due to the time elapsed since injury or ineffectiveness of prior conservative treatment. No significant differences in patient demographics were observed between the two groups. While Crawford classification and pain scores showed no significant differences between the groups (p>0.05), the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score and time to return to work significantly favored Group 2, which underwent perioperative modifying plate fixation (p<0.05).

Conclusion: Extension-block pinning is noted for its simplicity and favorable postoperative range of motion outcomes. In contrast, perioperative modifying plate fixation enhances stability and mechanical performance, positively impacting overall functional recovery. The choice between these techniques should consider procedural simplicity, perioperative demands, mechanical efficiency, and postoperative functional outcomes.