Is the Use of Biodegradable Devices in the Operative Treatment of Avulsion Fractures of Fingers, the So-Called Mallet Finger Advantageous? A Feasibility Study with Meniscus Arrows®

Purpose: Treatment of Mallet fingers or fractures remains a controversial topic. No evident preference can be distilled from the reports of the clinical results obtained by conservative treatment with splints and internal fixation. If operative treatment is indicated, several techniques can be used. However, each technique has disadvantages like the risk of comminution of the fragment, the risk of infection and necrosis, a demanding operative technique and-or the necessity of removing the metallic devices. This can be avoided by the use of biodegradable devices. The purpose of this feasibility study was to evaluate the outcome of internal fixation of a Mallet fracture with a biodegradable device, the Meniscus Arrow®. Methods: We treated nine consecutive patients with a Mallet fracture by fixation of the fragment with a biodegradable Meniscus Arrow®, at this moment the smallest device available, with an average operation time of 14 minutes. Results: Postoperatively, no complications were found. All patients were satisfied by the results after surgery, with a restored range of motion in the distal interphalangeal joint as previously and good alignment with full consolidation of all fractures at radiological evaluation. Conclusions: The operative treatment of bony mallet fingers with the Meniscus Arrow® is a fast procedure without complications in our prospective series of nine patients and without the need of a second operation to remove the implant.

Biomechanical Comparison of the FasT-Fix Meniscal Repair Suture System with Vertical Mattress Sutures and Meniscus Arrows

Background A meniscal repair technique that combines the strength of vertical mattress sutures and the decreased tissue morbidity of an all-inside technique would be advantageous. Hypothesis The FasT-Fix Meniscal Repair Suture System will provide load at failure, stiffness, and displacement equivalent to that of vertical mattress sutures and superior to that of Meniscus Arrows. Study Design In vitro biomechanical study. Methods After repair of a 2-cm vertical longitudinal medial meniscal lesion, three groups of six human cadaveric knees were biomechanically tested in a random order on a servohydraulic device, and three groups of five specimens underwent cyclic loading. Results Specimens repaired with Meniscus Arrows had reduced load at failure, stiffness, and displacement, but there were no differences between the FasT-Fix and vertical mattress suture methods. During cyclic loading, specimens repaired with two Meniscus Arrows failed before test completion, whereas specimens repaired with two vertical mattress sutures (6.0 ± 3.7 mm) or with two FasT-Fix implants (5.1 ± 1.4 mm) maintained fixation with comparable displacements. Conclusions The FasT-Fix provided load at failure, stiffness, and displacement comparable with that of vertical mattress sutures. Clinical Relevance The results suggest that the FasT-Fix may be preferable to Meniscus Arrows for meniscal repair with minimal associated tissue morbidity.