Clinical and Radiographic Outcomes of the Wrap-Around Extension Block Pinning Technique for Bony Mallet Fingers

TL;DR

This study evaluates a modified surgical technique for mallet finger fractures and finds it provides stable fixation but does not improve functional outcomes compared to standard methods.

Contribution

The paper introduces and evaluates the wrap-around extension block pinning technique for mallet finger fractures.

Findings

The wrap-around technique achieved 41.1% excellent/good outcomes with no postoperative complications.

Younger patient cohorts showed higher excellent/good outcome rates compared to older groups.

Functional recovery was more influenced by age and fracture severity than the specific fixation method.

Abstract

Aims and objectives

Mallet finger fractures with substantial dorsal fragments often require surgical intervention, particularly when associated with distal interphalangeal joint (DIPJ) subluxation. We evaluated the clinical outcomes of a modified fixation method, the wrap-around extension block pinning technique, designed to enhance dorsal fragment compression and reduce K-wire migration.

Materials and methods

We conducted a retrospective cohort study of all consecutive patients treated with the wrap-around technique at a single tertiary hand surgery center over five years. Seventeen patients with a minimum follow-up of four months were included. Demographic, clinical, and radiographic data were analyzed. Outcomes were assessed using Crawford's criteria, and the results were benchmarked against historical controls (Çapkın et al., Jain et al., and the surgical and conservative subgroups of Yoon et al.). Graphical analyses were used to visually explore the potential trend between the mean cohort age and outcome distributions.

Results

Seventeen patients (mean age, 39 years) were analyzed. The combined excellent/good rate was 41.1% (7/17), and no postoperative complications occurred in this cohort (0%; 0/17), with no cases of hardware failure or loss of reduction. Comparative descriptive analysis suggested an inverse trend between cohort mean age and the proportion of excellent/good outcomes across the analyzed studies, with younger published cohorts demonstrating higher excellent/good rates. The outcome distribution in the current series most closely resembled that of the surgically treated subgroup in Yoon et al., which also included older patients and more complex fracture patterns.

Conclusion

The wrap-around extension block pinning technique provided exceptionally stable fixation without complications but did not yield superior functional outcomes compared with the historical results of standard extension block pinning. Our observations suggest that age, fracture severity, and immobilization duration may be more strongly associated with functional recovery than the specific fixation constructs. While further comparative studies are needed, the technique offers a reliable alternative when construct stability is a priority.

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