The Treatment of Doyle Type 4b Mallet Fractures with Pull-Out Suture and Transarticular Kirschner Wire Fixation Technique

Abstract

Aim: In this study, we evaluated the results of the pull-out suture and transarticular Kirschner wire fixation technique in the treatment of Doyle type 4b mallet fractures. Methods: The study involved 15 patients (10 males, 5 females) with a mean age of 36.3 years (range: 15-55 years) who underwent surgery for mallet fracture between January 2005 and August 2013. Following the open reduction, pull-out suture and fixation with transarticular Kirschner wire were performed as the surgical method. The patients were assessed functionally and clinically according to the Crawford criteria. The mean follow-up period was 39.3 months (range: 6-99). Results: Radiographic union was achieved in all patients. None of the patients developed infection, skin necrosis, avascular necrosis, nail deformity, and degeneration or subluxation of the distal interphalangeal joint. According to the Crawford criteria, the results were excellent in 12 (80%) patients, good in two (13%) patients and moderate in one (7%) patient. None of the patients developed flexion loss and the mean extension loss was 1.5 degrees C (range: 0-15). Conclusion: Considering the satisfaction of both the patient and the surgeon, we suggest pull-out suturing and transarticular Kirschner wire application which is a satisfactory surgical method in the treatment of Doyle type 4b mallet fractures.