A Novel Hook Wire Tension Technique for the Treatment of Mallet Fractures: A Comparison with the Extension Block Pinning Technique

Summary We developed a percutaneous surgical technique which allows early mobilization and compression for the treatment of mallet fractures. The aim of this study was to describe this novel technique called the hook wire tension technique (HWTT) and provide a clinical and radiological comparison between HWTT and the extension block pinning technique (EBT) in the treatment of mallet fractures. This retrospective study included 23 mallet fracture patients treated using HWTT and 25 patients treated using EBT. At the final follow-up visit, extension lag and flexion of the distal interphalangeal joint (DIPJ) were measured. DIPJ pain was assessed with the visual analogue scale (VAS) score, and the overall clinical outcomes were graded according to the Crawford criteria. Time to bone healing and osteoarthritis development were assessed radiologically. Complications including skin necrosis, dorsal prominence and nail deformity were also compared. The mean follow-up period was 18 months (range: 12-24) in the HWTT group and 19.2 months (range: 12-26) in the EBT group (p = 0.239). There was no statistically significant difference between the two groups in terms of mean extension lag of the DIPJ, mean VAS scores and mean time to bone healing (p > 0.405). Mean DIPJ flexion was greater in the HWTT group compared to the EBT group (p = 0.001). According to the Crawford criteria, outcomes were similar in both groups (p = 0.370). No statistically significant difference was found between the two groups when each complication was compared (p > 0.358). The short-term clinical and functional results of HWTT were seen to be similar to those of EBT in the surgical treatment of mallet fractures.