Treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB / 中华骨科杂志

ABSTRACT

Objective@#Purpose To introduce the treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with endobutton CL bone-tendon-bone (BTB), and discuss its clinical effects.@*Methods@#From January 2010 to August 2013, 21patients (male 15, female 6) with mallet finger deformity were retrospectively studied. The average age of patients was 31.3±5.3 years. The time from injury to surgery was 5.2±2.1 d. Extensor tendons were ruptured at the terminal insertion in all patients, and there were no avulsion fracture at the base of the distal phalanx.. the terminal extensor tendon insertion Awere surgical reconstructed with Endobutton CL BTB, via a dorsal S-shaped incision of distal interphalangeal joint. Dorsal base of the distal phalanx was drilled a hole and then the tendon suture line with Endobutton CL BTBwas inserted from the ventral finger to the dorsal base of the phalanx to suture the proximal extensor tendon. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up the active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total active ranges of motion of the finger were recorded. Finger function was evaluated according to the total active range of motion (TAM) system of the American Association of hand Surgeons.@*Results@#All 21 cases were followed up and the follow-up period was 8 to 24 months, with an average of 18.6±5.1 months. The operation time of the patients was 20-40 min, with an average of 29.6±10.3 min. The intraoperative blood loss was 5-10ml, with an average of 7.5±2.6 ml. Mallet finger deformities were all corrected postoperatively. One case presented with limited dorsal extension with elongation of -20°. According to the Crawford evaluation standard, there were 18 excellent patients and 2 good patients, with the excellent and good rate was 95.2% (20/21). The degrees of active joint activity were 91°±7° of the metacar-pophalangeal joint, 92°±4° of the proximal interphalangeal joint, 82°±8° of the distal interphalangeal joint, and 259°±15° of total active activity. The TAMs of the healthy side were 259°±15°, and the TAMs of the affected side were 268°±12°, the difference was statistically significant (t=2.147, P=0.038). Accorrding to TAM system assessment criteria excellent in 18 patients, good in 2 patients, and the excellent and good rate was 95.2% (20/21). One case presented with dorsal extension limitation, one case suffered from discomfort of grip because of scar in ventral side of the finger. The postoperative dorsal extension was limited in 3 cases, and the postoperative dorsal extension function was gradually restored 6 months later.@*Conclusion@#The treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB was effective and easy-operating. Postoperative patients can perform early finger function exercise, satisfactory results, worthy of clinical promotion and application.