Archives of Hand and Microsurgery

  • 제23권4호
  • /
  • Pages.239-247
  • /
  • 2018
  • /
  • 2586-3290(pISSN)
  • /
  • 2586-3533(eISSN)
대한수부외과학회 (The Korean Society for Surgery of the Hand)
권호 표지
DOI QR코드

DOI QR Code

골성 추지 신전제한 K 강선 고정술 시행 후 정복소실

Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

  • 김병성 (순천향대학교 부천병원 정형외과) ;
  • 노재휘 (순천향대학교 서울병원 정형외과) ;
  • 정기진 (순천향대학교 천안병원 정형외과) ;
  • 윤건희 (순천향대학교 부천병원 정형외과) ;
  • 박은석 (순천향대학교 부천병원 정형외과) ;
  • 박성용 (서귀포의료원 정형외과)
  • 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)
  • 투고 : 2018.07.24
  • 심사 : 2018.09.17
  • 발행 : 2018.12.01
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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.

키워드

참고문헌

  1. Tetik C, Gudemez E. Modification of the extension block kirschner wire technique for mallet fractures. Clin Orthop Relat Res. 2002;(404):284-90.
  2. Pegoli L, Toh S, Arai K, Fukuda A, Nishikawa S, Vallejo IG. The Ishiguro extension block technique for the treatment of mallet finger fracture: indications and clinical results. J Hand Surg Br. 2003;28:15-7.
  3. Lee YH, Kim JY, Chung MS, Baek GH, Gong HS, Lee SK. Two extension block kirschner wire technique for mallet finger fractures. J Bone Joint Sur Br. 2009;91:1478-81.
  4. Jorgsholm P, Bjorkman A, Emmeluth C, Bjorkman- Burtscher IM. Extension block pinning of mallet fractures. Scand J Plast Reconstr Surg Hand Surg. 2010;44:54-8. https://doi.org/10.3109/02844310903351327
  5. Hofmeister EP, Mazurek MT, Shin AY, Bishop AT. Extension block pinning for large mallet fractures. J Hand Surg Am. 2003;28:453-9. https://doi.org/10.1053/jhsu.2003.50089
  6. Bendre AA, Hartigan BJ, Kalainov DM. Mallet finger. J Am Acad Orthop Surg. 2005;13:336-44. https://doi.org/10.5435/00124635-200509000-00007
  7. Ishiguro T, Itoh Y, Yabe Y, Hashizume N. Extension block with kirschner wire for fracture dislocation of the distal interphalangeal joint. Tech Hand Up Extrem Surg. 1997;1:95-102. https://doi.org/10.1097/00130911-199706000-00005
  8. Theivendran K, Mahon A, Rajaratnam V. A novel hook plate fixation technique for the treatment of mallet fractures. Ann Plast Surg. 2007;58:112-5. https://doi.org/10.1097/01.sap.0000232858.80450.27
  9. Lucchina S, Badia A, Dornean V, Fusetti C. Unstable mallet fractures: a comparison between three different techniques in a multicenter study. Chin J Traumatol. 2010;13:195-200.
  10. Schweitzer TP, Rayan GM. The terminal tendon of the digital extensor mechanism: part II, kinematic study. J Hand Surg Am. 2004;29:903-8. https://doi.org/10.1016/j.jhsa.2004.04.025
  11. Hahn SB, Park GH, Choi YR, Kang HJ, Lee JK. Prognostic factors of the extension block technique for the bony mallet finger. J Korean Orthop Assoc. 2010;45:127-32. https://doi.org/10.4055/jkoa.2010.45.2.127
  12. Crawford GP. The molded polythene splint for mallet finger deformities. J Hand Surg Am. 1984;9:231-7. https://doi.org/10.1016/S0363-5023(84)80148-3
  13. Wehbe MA, Schneider LH. Mallet fractures. J Bone Joint Surg Am. 1984;66:658-69. https://doi.org/10.2106/00004623-198466050-00003
  14. Husain SN, Dietz JF, Kalainov DM, Lautenschlager EP. A biomechanical study of distal interphalangeal joint subluxation after mallet fracture injury. J Hand Surg Am. 2008;33:26-30. https://doi.org/10.1016/j.jhsa.2007.09.006
  15. Pike J, Mulpuri K, Metzger M, Ng G, Wells N, Goetz T. Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger. J Hand Surg Am. 2010;35:580-8. https://doi.org/10.1016/j.jhsa.2010.01.005
  16. Segmueller HE. Mallet finger injuries. J Hand Surg Am. 2010;35:693; author reply 693-4.
  17. Kim JY, Lee SH. Factors related to distal interphalangeal joint extension loss after extension block pinning of mallet finger fractures. J Hand Surg Am. 2016;41:414-9. https://doi.org/10.1016/j.jhsa.2015.11.026
  18. Chung DW, Lee JH. Anatomic reduction of mallet fractures using extension block and additional intrafocal pinning techniques. Clin Orthop Surg. 2012;4:72-6. https://doi.org/10.4055/cios.2012.4.1.72
  19. Shin SH, Lee YS, Kang JW, Kang W, Chung YG. Tips under the skin: a simple modification of extension block pinning for mallet fractures. Orthopedics. 2018;41:e299-302. https://doi.org/10.3928/01477447-20180226-05