Analysis of Surgical Techniques for Avulsion Fractures of the Distal Phalanges in Children

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

BACKGROUND: Avulsion intra-articular fractures account for up to 18% of all bony injuries of the distal phalanx among children. Currently, there is no unified approach for the surgical treatment of such injuries. The Ishiguro technique is an alternative to open reduction; however, experience with its use in pediatric traumatology is limited.

AIM: This study aimed to determine the optimal surgical technique for avulsion intra-articular fractures of the distal phalanges in children by comparing the outcomes of open reduction with fixation of the peripheral fragment and of minimally invasive reduction with osteosynthesis using the Ishiguro method.

METHODS: A prospective cohort study was conducted at Traumatology Departments Nos. 1 and 2 of the Children’s City Clinical Hospital No. 9, Yekaterinburg. Twenty-nine children with avulsion intra-articular fractures of the distal phalanges, with displacement greater than one-third of the articular surface, were included. In the main group (n = 15), minimally invasive reduction and osteosynthesis using the Ishiguro technique were performed; in the control group (n = 14), open reduction and fixation of the peripheral fragment with a wire were conducted. Local inflammatory changes were assessed on postoperative days 3 and 7. The range of motion in the distal interphalangeal joint was measured using a goniometer at 1, 2, and 4 weeks after implant removal.

RESULTS: The main group demonstrated significantly more effective restoration of distal interphalangeal joint motion: 17.80° ± 7.43° versus 7.79° ± 3.40° at 1 week after implant removal (p < 0.001); 57.47° ± 13.11° versus 28.86° ± 12.09° at 2 weeks (p < 0.001); and 89 [85; 90]° versus 78.50 [77.25; 83.00]° at 4 weeks (p < 0.001). Macroscopic evaluation of pin entry sites on postoperative days 3 and 7 showed no significant differences between the groups (p > 0.05). Fracture consolidation was achieved in all cases. Peripheral fragment comminution was observed in one patient from the control group.

CONCLUSION: The Ishiguro osteosynthesis technique may be recommended as the method of choice for treating children with intra-articular avulsion fractures of the distal phalanges owing to its technical reproducibility, minimal invasiveness, and favorable functional outcomes.

About the authors

Ivan I. Gordienko

Ural State Medical University; Children’s City Clinical Hospital No. 9, Yekaterinburg

Author for correspondence.
Email: ivan-gordienko@mail.ru
ORCID iD: 0000-0003-3157-4579
SPIN-code: 5368-0964

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Yekaterinburg; Yekaterinburg

Anastasia E. Slukina

Ural State Medical University

Email: anast.slukina@gmail.com
ORCID iD: 0009-0000-3431-7813
SPIN-code: 5149-4840
Russian Federation, Yekaterinburg

Natalia A. Tsap

Ural State Medical University; Children’s City Clinical Hospital No. 9, Yekaterinburg

Email: tsapna-ekat@rambler.ru
ORCID iD: 0000-0001-9050-3629
SPIN-code: 7466-8731

MD, Dr. Sci. (Medicine), Professor, Honored Doctor of the Russian Federation

Russian Federation, Ekaterinburg; Ekaterinburg

References

  1. Abzug JM, Dua K, Bauer AS, et al. Pediatric phalanx fractures. J Am Acad Orthop Surg. 2016;24(11):e174–e183. doi: 10.5435/JAAOS-D-16-00199
  2. Chen AT, Conry KT, Gilmore A, et al. Outcomes following operative treatment of adolescent mallet fractures. HSS J. 2018;14(1):83–87. doi: 10.1007/s11420-017-9563-7
  3. Lankachandra M, Wells CR, Cheng CJ, Hutchison RL. Complications of distal phalanx fractures in children. J Hand Surg Am. 2017;42(7):574.e1–574.e6. doi: 10.1016/j.jhsa.2017.03.042
  4. Khera B, Chang C, Bhat W. An overview of mallet finger injuries. Acta Biomed. 2021;92(5):e2021246. doi: 10.23750/abm.v92i5.11731
  5. Nashi N, Sebastin SJ. A pragmatic and evidence-based approach to mallet finger. J Hand Surg Asian Pac Vol. 2021;26(3):319–332. doi: 10.1142/S2424835521400063 EDN: RAYFCW
  6. Lin JS, Samora JB. Surgical and nonsurgical management of mallet finger: a systematic review. J Hand Surg Am. 2018;43(2):146–163.e2. doi: 10.1016/j.jhsa.2017.10.004
  7. Lin JS, Samora JB. Outcomes of splinting in pediatric mallet finger. J Hand Surg Am. 2018;43(11):1041.e1–1041.e9. doi: 10.1016/j.jhsa.2018.03.037
  8. Niechajev IA. Conservative and operative treatment of mallet finger. Plast Reconstr Surg. 1985;76(4):580–585. doi: 10.1097/00006534-198510000-00019
  9. Wang WC, Hsu CE, Yeh CW, et al. Functional outcomes and complications of hook plate for bony mallet finger: a retrospective case series study. BMC Musculoskelet Disord. 2021;22(1):281. doi: 10.1186/s12891-021-04163-2 EDN: FZEZCH
  10. Rocchi L, Fulchignoni C, De Vitis R, et al. Extension block pinning vs single Kirshner wiring to treat bony mallet finger: a retrospective study. Acta Biomed. 2022;92(S3):e2021535. doi: 10.23750/abm.v92iS3.12484
  11. Janarv PM, Wikström B, Hirsch G. The influence of transphyseal drilling and tendon grafting on bone growth: an experimental study in the rabbit. J Pediatr Orthop. 1998;18(2):149–154.
  12. Hara A. Conservative treatment of chronic mallet fracture non-union after failed pin fixation. Asp Biomed Clin Case Rep. 2020;3(1):25–28. doi: 10.36502/2020/ASJBCCR.6181
  13. Gordienko II, Tsap NA, Kutepov SM. Treatment of fractures of the main phalanx of the fingers in children. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2022;10(3):247–253. doi: 10.17816/PTORS108751 EDN: KIQVXZ
  14. Segond P. Note on a case of tearing off the insertion point of the small phalangeal laguettes of the extensor of the little finger, by force bending of the phalangette on the phalagina. The Medical Progress. 1880;VIII:534–535. (In French.)
  15. Shankar NS, Goring CC. Mallet finger: long-term review of 100 cases. J R Coll Surg Edinb. 1992;37(3):196–198.
  16. Wehbé MA, Schneider LH. Mallet fractures. J Bone Joint Surg Am. 1984;66(5):658–669.
  17. Volkova YS, Rodomanova LA. Management of mallet finger: current status (review). Traumatology and Orthopedics of Russia. 2022;28(4):183–192. doi: 10.17816/2311-2905-1996 EDN: ZDEMEA
  18. 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(2):95–102. doi: 10.1097/00130911-199706000-00005
  19. Usami S, Kawahara S, Kuno H, et al. A retrospective study of closed extension block pinning for mallet fractures: analysis of predictors of postoperative range of motion. J Plast Reconstr Aesthet Surg. 2018;71(6):876–882. doi: 10.1016/j.bjps.2018.01.041
  20. Capkin S. Extension-block pinning to treat bony mallet finger: is a transfixation pin necessary? Ulus Travma Acil Cerrahi Derg. 2019;25(3):281–286. doi: 10.5505/tjtes.2018.59951
  21. Perez-Lopez LM, Perez-Abad M, Suarez Merchan MA, Cabrera Ortiz DA. Reverse Ishiguro extension block technique as an alternative for irreducible osseous mallet finger. Tech Hand Up Extrem Surg. 2024;28(2):62–66. doi: 10.1097/BTH.0000000000000465 EDN: GJVPKD
  22. Gergő J, Dániel K, Zsolt O. The Ishiguro technique for the treatment of mallet finger fracture in adolescent. Nov Tech Arthritis Bone Res. 2017;1(1):555552. doi: 10.19080/NTAB.2017.01.555552
  23. Gordienko II, Slukina AE, Shilina SA, Tsap NA. Comparative analysis of the results of treatment for metacarpal neck fractures in children with antegrade and retrograde Kirschner wire fixation. Ural Medical Journal. 2024;23(5):32–42. doi: 10.52420/umj.23.5.32 EDN: DDDPEH
  24. Acciaro AL, Gravina D, Pantaleoni F, et al. Retrospective study of Ishiguro’s technique for mallet bone finger in children: long-term follow-up and analysis of predictors in outcomes. Int Orthop. 2024;48(6):1501–1506. doi: 10.1007/s00264-024-06162-z EDN: FDZJKS

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. X-ray of a 14-year-old child with an avulsion fracture of the base of the nail phalanx (mallet fracture) of the third finger of the right hand with displacement.

Download (142KB)
Indexing metadata
3. Fig. 2. Surgical treatment diagram using open reduction and osteosynthesis of the peripheral fragment: 1 — pin fixing the peripheral fragment; 2 — pin fixing the phalanges of the fingers in a position of decreased flexor tone.

Download (59KB)
Indexing metadata
4. Fig. 3. Surgical treatment stages using the Ishiguro method: a — flexion of the distal phalanx and insertion of a Kirschner wire into the middle phalanx above the peripheral fragment; b — extension of the distal phalanx and reposition of the fragment; c — transarticular fixation of the distal interphalangeal joint in an extension position; d — appearance of the finger at the end of the surgery.

Download (129KB)
Indexing metadata
5. Fig. 4. Indicators of range of motion in the distal interphalangeal joint in patients of the main and control groups: DIPJ - distal interphalangeal joint.

Download (90KB)
Indexing metadata

Copyright (c) 2025 Эко-Вектор

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).