Archives of Hand and Microsurgery

The Korean Society for Surgery of the Hand (대한수부외과학회)
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Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

골성 추지 신전제한 K 강선 고정술 시행 후 정복소실

  • Kim, Byungsung (Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital) ;
  • Nho, Jae-Hwi (Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital) ;
  • Jung, Ki Jin (Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital) ;
  • Yun, Keonhee (Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital) ;
  • Park, Eunseok (Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital) ;
  • Park, Sungyong (Department of Orthopedic Surgery, Seogwipo Medical Center)
  • 김병성 (순천향대학교 부천병원 정형외과) ;
  • 노재휘 (순천향대학교 서울병원 정형외과) ;
  • 정기진 (순천향대학교 천안병원 정형외과) ;
  • 윤건희 (순천향대학교 부천병원 정형외과) ;
  • 박은석 (순천향대학교 부천병원 정형외과) ;
  • 박성용 (서귀포의료원 정형외과)
  • Received : 2018.07.24
  • Accepted : 2018.09.17
  • Published : 2018.12.01
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Abstract

Purpose: We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger. Methods: Forty-six patients were included with a mean follow-up of 28 months (range, 12-54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford's criteria. Results: Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a significant relationship between gap or step-off and extension lag. Using Crawford's evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients. Conclusion: Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.

목적: 골성 추지의 치료로 신전 제한 K 강선 고정 또는 추가 골편간 고정 후 발생한 정복 소실과 원위지관절 신전지연을 포함한 임상적 결과를 분석하였다. 방법: 평균 추시 기간 28개월(12-54개월)의 46명을 대상으로 하였고, 27명은 신전 제한 K 강선 고정(A군)으로, 19명은 추가 골편 간 고정(B군)으로 치료하였다. 관절면 침범 정도, 전방아탈구, 추지 골편각, 정복 소실, 관절운동 범위, Crawford 기준을 이용한 기능적 결과를 평가하였다. 결과: 정복 소실은 8예(17%)에서 발생하였다. 신전 제한 정도, 연령, 술 전 전방아탈구 및 추지 골편각은 정복 소실여부에 따른 차이가 유의하였으나 성별, 우세 수, 관절면 침범 정도 및 추가 골편 간 고정은 정복 소실 여부에 따른 차이가 유의하지 않았다. 전위 양상은 골편 틈 또는 계단 변형은 신전 제한과 상관관계가 있었다. Crawford 기준상 우수 31, 양호 10, 보통 3, 그리고 불량이 2예였다. 결론: 고령, 적은 추지 골편각, 술 전 전방아탈구가 있는 경우는 정복 소실에 대한 주의가 필요하다.

Keywords

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