SURGICAL AND ORTHOPEDIC TREATMENT FOR MAL LET FINGER - A SERIES OF 216 CASES

Purpose of the study To assess the late results of orthopaedic and sur gical treatment for mallet finger, two groups of patients were reviewe d in a retrospective study. Material and methods 156 fingers (Group I) had conservative treatment and 60 fingers (Group II) some form of sur gical treatment. Results In Group I, a dorsal custom-made perforated s plint maintained the distal interphalangeal joint (DIP) in extension f or an average of 54 days (st13). The mean delay of presentation was 22 days (st36). Initial lack of extension was 35 degrees (st13). After a n average follow-up of 154 days (st240), the lack of extension was onl y 7 degrees with an active range of flexion of 61 degrees (st11). 68 o f these patients were reviewed for a long-term assessment (61 months). At this time, lack of extension and range of flexion were not differe nt (respectively 5 degrees - st10 and 61 degrees - st16). In Group II, 45 per cent of patients had initially some form of orthopaedic treatm ent. Delay between injury and consultation was 118 days (st250). Revie w with a mean follow-up of 5.6 years demonstrated a lack of extension and a DIP joint flexion of 12 degrees and 53 degrees for tenodermodesi s (14 cases), 2 degrees and 59 degrees for the Thompson and Littler pr ocedures (14 cases), 1 degrees and 55 degrees for the Fowler tenotomy (10 cases). Discussion and conclusion Orthopaedic treatment gave good functional results even in cases with delay of presentation. Surgery i s only indicated in failure of conservative treatment. in absence of s wan-neck deformity, tenodermodesis is a simple and effective technique . When a swan-neck is present, if the DIP deformity is corrected by PI P stabilization, the Fowler tenotomy is used. Otherwise, the Thompson and Littler operation allows to fully correct the deformity.