Extension Pin Block vs Pin Orthosis-extension Block Pinning for Bonny Mallet Fractures

Study Overview
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Brief Summary
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This is a single center prospective study comparing the extension pin block vs pin orthosis-extension block pinning for bonny mallet fractures.

Detailed Description
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Mallet finger is a fracture of the distal phalanx involving the dorsal articular surface. It is important because it concerns the extensor tendon attachment site. The clinical manifestation of mallet finger formation is active extension loss at the DIP joint. If the injury is not treated and becomes chronic, the DIP passive extension is gradually lost and a hyperextension posture occurs in the PIP joint due to the compensatory swan neck deformity. Non-surgical methods have an important place in the treatment of mallet finger injuries. The indications for surgical treatment of mallet finger injuries are a matter of debate. Conditions that are widely accepted as definite surgical indications are open injury, individuals who cannot work with a splint, the ruptured dorsal part is large and includes more than 30% of the articular surface, and the presence of palmar subluxation in the DIP. Among the mallet finger surgical treatments, the extension pin block technique , bracing in extension, hook method are defined. In this prospective study, we aimed to compare the extension pin block technique with the pin orthosis-extension block pinning. In comparison, the patients eligible for the study will be evaluated according to Crawford criteria for function evaluation, complications (infection, nail deformities, skin necrosis, DIP joint osteoarthritis), recovery time.

Official Title
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Extension Pin Block vs Pin Orthosis-extension Block Pinning for Bonny Mallet Fractures

Conditions
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Mallet Finger

Intervention / Treatment
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* Procedure: cextension pin block
* Procedure: pin orthosis- extension block pin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years and older patients Wehbe classification type 2 b (Type Definition) I No DIP joint subluxation II DIP joint subluxation III Epiphyseal and physeal injuries Subtype A Avulsed fragment <1/3 of articular surface B Avulsed fragment 1/3-2/3 of articular surface C Avulsed fragment >2/3 of articular surface ) Isolated bonny mallet fractures Minimum 1 year follow up Good cognitive status Exclusion Criteria: Patients under the age of 18 Open fracture Chronic mallet finger TFracture area that includes more than 50% of the joint face Patients whose follow-up less than 1 year

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: extension pin block<br>this is the technique for mallet finger where 2 pins are used, one for the extension block and other intramedullary for the extension posture | Procedure: cextension pin block<br>* this is the technique for mallet finger where 2 pins are used, one for the extension block and other intramedullary for the extension posture<br>|
| Active Comparator: pin orthosis- extension block pin<br>this is the technique for mallet finger where only 1 pin is used for extension block and an orthosis is applied for the extension posture | Procedure: pin orthosis- extension block pin<br>* this is the technique for mallet finger where only 1 pin is used for extension block and an orthosis is applied for the extension posture<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Crawford criteria | functional scoring for the DIP joint, focuses on range of motion and pain | postoperative 1st day | 
| Crawford criteria | functional scoring for the DIP joint, focuses on range of motion and pain | postoperative 1st month | 
| Crawford criteria | functional scoring for the DIP joint, focuses on range of motion and pain | postoperative 3rd month | 
| Crawford criteria | functional scoring for the DIP joint, focuses on range of motion and pain | postoperative 6th month | 
| Crawford criteria | functional scoring for the DIP joint, focuses on range of motion and pain | postoperative 12th month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| complications | skin necrosis, loss of range of motion, infection, nail bed injury | postoperative 1st day | 
| complications | skin necrosis, loss of range of motion, infection, nail bed injury | postoperative 1st month | 
| complications | skin necrosis, loss of range of motion, infection, nail bed injury | postoperative 3rd month | 
| complications | skin necrosis, loss of range of motion, infection, nail bed injury | postoperative 6th month | 
| complications | skin necrosis, loss of range of motion, infection, nail bed injury | postoperative 12th month |