scholarly journals Two Extension Block Kirschner Wires’ Technique for Bony Mallet Thumb

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Yutaka Mifune ◽  
Atsuyuki Inui ◽  
Fumiaki Takase ◽  
Yasuhiro Ueda ◽  
Issei Shinohara ◽  
...  
Keyword(s):  
Avulsion Fracture ◽  
Articular Surface ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Distal Phalanx ◽  
Extensor Mechanism ◽  
Kirschner Wires ◽  
Fracture Fragment ◽  
Conservative And Operative Treatment ◽  
Digital Block

Mallet fingers with an avulsion fracture of the distal phalanx or rupture of the terminal tendon of the extensor mechanism is known as a common injury, while mallet thumb is very rare. In this paper, the case of a 19-year-old woman with a sprained left thumb sustained while playing basketball is presented. Plain radiographs and computed tomography revealed an avulsion fracture involving more than half of the articular surface at the base of the distal phalanx. Closed reduction and percutaneous fixation were performed using the two extension block Kirschner wires’ technique under digital block anesthesia. At 4 months postoperatively, the patient had achieved excellent results according to Crawford’s evaluation criteria and had no difficulties in working or playing basketball. Various conservative and operative treatment strategies have been reported for management of mallet thumb. We chose the two extension block Kirschner wires’ technique to minimize invasion of the extensor mechanism and nail bed and to stabilize the large fracture fragment.

REVIEW ON MALLET FINGER TREATMENT

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 439-447 ◽  
Author(s):  
Jason Pui Yin Cheung ◽  
Boris Fung ◽  
Wing Yuk Ip
Keyword(s):  
Avulsion Fracture ◽  
Articular Surface ◽  
Extensor Tendon ◽  
Distal Phalanx ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Dorsal Aspect ◽  
Surgical Fixation ◽  
Distal Interphalangeal ◽  
Open Injuries

Mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of the terminal extensor tendon. It is usually caused by a forceful blow to the tip of the finger causing sudden flexion or a hyperextension injury. Fracture at the dorsal aspect of the base of the distal phalanx is commonly associated with palmar subluxation of the distal phalanx. Most mallet finger injuries are recommended to be treated with immobilisation of the distal interphalangeal joint in extension by splints. There is no consensus on the type of splint and the duration of use. Most studies have shown comparable results with different splints. Surgical fixation is still indicated in certain conditions such as open injuries, avulsion fracture involving at least one third of the articular surface with or without palmar subluxation of the distal phalanx and also failed splinting treatment.

A MODIFIED TENSION BAND WIRING TECHNIQUE FOR TREATMENT OF THE BONY MALLET FINGER

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 235-242 ◽  
Author(s):  
Ryosuke Kakinoki ◽  
Soichi Ohta ◽  
Takashi Noguchi ◽  
Yukitoshi Kaizawa ◽  
Hiromu Itoh ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Surgical Intervention ◽  
Articular Surface ◽  
Steel Wire ◽  
Distal Phalanx ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Stainless Steel Wire ◽  
Mallet Finger ◽  
Fracture Fragment

Purpose: To report the outcomes of mallet fractures treated with our modified tension band wiring technique. Methods: Eleven men and two women (mean age; 33 years) with mallet fractures in which happened more than five weeks before surgery, or with fracture fragments involving more than 2/3 or less than 1/3 of the distal phalanx articular surface or with previous surgical intervention, were subjected to this study. The fracture fragment was fixed with a modified tension band wiring technique using a stainless steel wire and an injection needle. Results: All patients achieved bone union in nine weeks in average. All patients had no pain except one with mild pain. No patient showed a gap or step-off greater than 1 mm. Conclusions: Our tension band wiring technique can be used regardless of the size of the dorsal fracture fragment or the interval between injury and surgery.

scholarly journals Management for Bony Mallet Thumb with a Single Extension Blocking Kirschner Wire

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Sean-Tee J.M Lim ◽  
Muhammad Abrar Qadeer ◽  
Martin Kelly ◽  
Brian Lenehan
Keyword(s):  
Closed Reduction ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Treatment Strategies ◽  
Extensor Tendon ◽  
Conservative And Operative Treatment ◽  
Bone Injury ◽  
Finger Injury ◽  
Mallet Fracture ◽  
Distal Interphalangeal

Introduction: Mallet finger injury is defined by disruption of the terminal extensor tendon distal-to-distal interphalangeal (DIP) joint. While in the fingers, it is a relatively common injury, it is a rarely encountered entity when involving the thumb. Various conservative and operative treatment strategies have been reported for the management of mallet thumb with no consensus by clinicians. Case Report: We present the case of a 27-year-old right hand dominant man with a left bony mallet thumb injury that occurred while playing hurling. Hurling is traditional Irish sport that is one of the fastest field games in the world, involving the use of a wooden Hurley and ball. Clinically, there was loss of active extension at the DIP joint of the non-dominant thumb with radiographs revealing an avulsion fracture involving more than one-third of the articular surface at the base of the distal phalanx. Closed reduction and percutaneous fixation using a single extension block Kirschner wire was performed without a transfixion wire across the DIP joint. Four months postoperatively, the patient had regained that good functional dexterity was able to return to playing hurling. Conclusion: A single K-wire technique may be beneficial with theoretical reduction of chance of iatrogenic nail bed, bone fragment rotation, chondral damage, and bone injury. To the best of our knowledge, no previous reports of its application to bony mallet thumb have been described. Keywords: Mallet fracture, K-wire, hurling, trauma, closed reduction

Laceration of Femoral Vessels by an Avulsion Fracture Fragment of the Lesser Trochanter After Bipolar Hemiarthroplasty

2005 ◽  
Vol 20 (5) ◽  
pp. 680-683 ◽  
Author(s):  
Yong-Chan Ha ◽  
Simion Luminita ◽  
Se-Hyun Cho ◽  
Jun-Young Choi ◽  
Kyung-Hoi Koo
Keyword(s):  
Avulsion Fracture ◽  
Bipolar Hemiarthroplasty ◽  
Fracture Fragment ◽  
Lesser Trochanter ◽  
Femoral Vessels

Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

2018 ◽  
Vol 39 (8) ◽  
pp. 978-983
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
R. Frank Henn ◽  
Rebecca A. Cerrato
Keyword(s):  
Clinical Practice ◽  
Clinical Relevance ◽  
Articular Surface ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Lateral View ◽  
Joint Surface ◽  
Foot And Ankle ◽  
Kirschner Wires

Background: Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. Methods: Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. Conclusion: Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. Clinical Relevance: This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.

scholarly journals Nivolumab and Ipilimumab in the Treatment of Metastatic Uveal Melanoma: A Single-Center Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Vidhya Karivedu ◽  
Ihab Eldessouki ◽  
Ahmad Taftaf ◽  
Zheng Zhu ◽  
Abouelmagd Makramalla ◽  
...  
Keyword(s):  
Partial Response ◽  
Clinical Outcome ◽  
Uveal Melanoma ◽  
Stable Disease ◽  
Checkpoint Inhibitors ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Case Series ◽  
Retrospective Case ◽  
Study Results

Background. Metastatic uveal melanoma (MUM) is associated with a poor prognosis, with a median overall survival (OS) of 4–15 months. Despite new insights into the genetic and molecular background of MUM, satisfactory systemic treatment approaches are currently lacking. The study results of innovative treatment strategies are urgently needed. Patients and Methods. This was a retrospective case series of 8 patients with MUM managed at the University of Cincinnati between January 2015 and January 2018. The immune-related Response Evaluation Criteria in Solid Tumors (irRECIST) 1.1 criteria were used for patient evaluation, and magnetic resonance imaging was used for evaluation at treatment checkpoints. Objective. To assess the clinical outcome of patients with MUM treated with a combination of checkpoint inhibitors. Results. The series included eight patients, six men and two women, with MUM. Their median age at MUM diagnosis was 69 (range, 55–77) years. All patients were treated with ipilimumab and nivolumab combination along with transarterial chemoembolization (TACE), followed by nivolumab maintenance and monthly TACE procedures. The majority of patients had a partial response or stable disease. Two of the patients had partial response, while four others had stable disease. Two other patients experienced disease progression. Conclusion. We report the outcomes of eight patients with MUM treated with the combination of ipilimumab and nivolumab. We report the clinical outcome and toxicity associated with this treatment approach. Further studies are warranted to explore immunotherapy in MUM. These findings support the consideration of immunotherapy in MUM.

The use of frame fixation in the management of open distal extensor mechanism avulsion fracture in a dislocated knee

2007 ◽  
Vol 15 (11) ◽  
pp. 1346-1349 ◽  
Author(s):  
Yasuhiro Yamaoka ◽  
Takatomo Mine ◽  
Hiroshi Tanaka ◽  
Yoichiro Ishida ◽  
Tosihiko Taguchi
Keyword(s):  
Avulsion Fracture ◽  
Extensor Mechanism

Experience with Sorafenib in 3 Hospitals in Sao Paulo

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Rogério Camargo-Pinheiro-Alves ◽  
Daniele E. Viera-Alves ◽  
Arthur Malzyner ◽  
Otavio Gampel ◽  
Thaisa de F. Almeida-Costa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Complex Disease ◽  
Objective Response ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Sao Paulo ◽  
Advanced Hepatocellular Carcinoma ◽  
São Paulo ◽  
Sorafenib Therapy

Introduction and aim. Sorafenib has been the standard of care for first-line treatment of advanced hepatocellular carcinoma, a complex disease that affects an extremely heterogenous population. Thereby requiring multidisciplinary individualized treatment strategies that match the disease characteristics and the patients’ specific needs. Material and methods. Data for 175 patients who received sorafenib for hepatocellular carcinoma in three different hospitals in Sao Paulo, Brazil over a span of nine years were retrospectively analyzed. Results. The median age was 62 years. Percentages of patients with Child-Pugh A, B and C liver cirrhosis were 61%, 31% and 5%, respectively. Approximately half of the patients had Barcelona Clinic Liver Cancer stage B disease, and the other half had stage C. The median treatment duration was 253 days. Sorafenib dose was reduced to 400 mg/day in 41% of the patients due to toxicity. Overall objective response rate as per Response Evaluation Criteria in Solid Tumors and its modified version was 39%. Patients who received transarterial chemoembolization (TACE) at any point during sorafenib therapy were significantly more likely to experience an objective response. After a median follow-up of 339 days, the median overall survival was 380 days. Child-Pugh cirrhosis, tumor response and concomitant chemoembolization were independent prognostic factors for overall survival in multivariate analysis. Conclusion. Our results suggest that, in experienced hands, sorafenib therapy may benefit carefully selected hepatocellular carcinoma patients for whom other therapies are initially contraindicated, including those patients with Child-Pugh B liver function and those patients who are subsequently treated with concomitant TACE.

scholarly journals Conservative Treatment of Chronic Mallet Fracture Non-union after Failed Pin Fixation

2020 ◽  
Vol 3 (1) ◽  
pp. 25-28
Author(s):  
Hara A
Keyword(s):  
Conservative Treatment ◽  
Articular Surface ◽  
Functional Results ◽  
Fracture Site ◽  
Distal Phalanx ◽  
Joint Surface ◽  
Mallet Finger ◽  
Non Union ◽  
Mallet Fracture ◽  
Pin Fixation

Introduction: Operative treatment of mallet finger fractures is generally recommended for patients in whom more than one-third of the articular surface is involved with volar subluxation. We present a case of conservative treatment with chronic nonunion of a mallet finger fracture after failed mallet finger surgery. Presentation of Case: A 16-year-old boy presented with a bony fragment (mallet formation) of his left long finger. The fragment occupied 40% of the articular surface, with volar subluxation of the distal phalanx. Percutaneous needle curettage of the fracture site and pinning were performed. Six weeks later, the fragment was displaced and had rotated. Hence, all the pins were removed, and a splint was applied. The fracture displayed nonunion and volar subluxation of the distal phalanx. The patient continued with the splinting, and the fracture finally healed. At 27 months after the surgery, radiological examination showed very good remodeling of the distal interphalangeal joint surface with anatomic joint congruence. Functional results at 27 months were good according to Crawford’s classification. Conclusion: Chronic nonunion of a mallet finger can be cured conservatively even when a fracture gap is seen along with displacement of the fragment and volar subluxation of the distal phalanx.

scholarly journals Traditional Approach vs Posterior Approach for Ankle Fractures Involving the Posterior Malleolus

2020 ◽  
pp. 107110072096943
Author(s):  
Kristian Pilskog ◽  
Teresa Brnic Gote ◽  
Heid Elin Johannessen Odland ◽  
Knut Andreas Fjeldsgaard ◽  
Håvard Dale ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Traditional Approach ◽  
Articular Surface ◽  
Treatment Strategies ◽  
Outcome Evaluation ◽  
Ankle Fractures ◽  
Posterior Malleolus ◽  
Patient Reported ◽  
Group A ◽  
Group B

Background: In the past, posterior malleolus fragments (PMFs) commonly have been indirectly reduced and fixed when fragments involve 25% or more of the tibial articular surface, while smaller fragments were left unfixed. The posterior approach has become increasingly popular and allows fixation of even smaller fragments. This study compares clinical outcome for the 2 treatment strategies. Methods: Patients with ankle fractures involving a PMF treated from 2014 to 2016 were eligible for inclusion. Patients were allocated to group A (treated with a posterior approach) or group B (treated with the traditional approach) according to the treatment given. A one-to-one matching of patients from each group based on the size of the PMF was performed. Patient charts were reviewed, and outcome evaluation was performed clinically, radiographically, and by patient-reported outcome measures (PROMs; Self-Reported Foot and Ankle Score, RAND-36, visual analog scale [VAS] of pain, and VAS of satisfaction). Forty-three patients from each group were matched. Median follow-up was 26 (interquartile range [IQR], 19-35) months postoperatively. Results: The median PMF size was 17% (IQR, 12-24) in both groups, and they reported similar results in terms of PROMs. Fixation of the PMF was performed in 42 of 43 (98%) patients in group A and 7 of 43 (16%) patients in group B ( P < .001). The former group more frequently got temporary external fixation (56% vs 12%, P < .01) and less frequently had syndesmotic fixation (14% vs 49%, P < .01), and they had less mechanical irritation and hardware removal but more noninfectious skin problems (28% vs 5%, P < .01). Median time from injury to definitive surgery (8 vs 0 days, P < .001) and median length of stay (12 vs 3 days, P < .001) were longer in group A. Conclusion: Comparison of treatment strategies for ankle fractures involving the posterior malleolus showed similar results between patients treated with a traditional approach and a posterior approach. Level of Evidence: Level III, retrospective comparative study.

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