Anatomical and clinical study of a new mallet fracture classification method  

作　　者：Yong Yang Wei-Guang Zhang Zhong-Zhe Li Shan-Lin Chen Wen Tian 

机构地区：[1]Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China [2]Department of Human Anatomy,Histology and Embryology,Peking University School of Basic Medical Sciences,Beijing 100191,China

出　　处：《Chinese Medical Journal》2020年第6期657-663,共7页中华医学杂志（英文版）

基　　金：This study was supported by the Beijing Health System Project for High-level Technical Scholars(No.2015-3-036).

摘　　要：Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fractures,invest电ate a new mallet fracture classification system using anatomical and imaging methods,and discuss the treatment schemes for different types of mallet fracture.Methods:Sixty-four fresh cadaveric fingers were divided into four groups,and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%,50%,75%,and 100% of the bilateral collateral ligaments.The the stability of the distal interphalangeal joint was them observed.The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture,the thickness of fracture,the untreated time after injury,and the complication of distal interphalangeal joint palmar subluxation.Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion,the Ishiguro method,or single Kirschner wire fixation.Results:The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral effect of mallet fractures on was then observed.The lateral radiographs of mallet ligaments were cut off by 25%(t=-0.415,P=0.684)and significantly unstable when this range was≥50%(50% transection:t=-6.363,P<0.001;75% transection:t=-17.036,P<0.001;100%transection:t=-30.977,P<0.001,respectively).The mallet fractures were divided into Types Ⅰ,Ⅱ,and Ⅲ(fracture involving<20%,20%-50%,and>50% of the joint surface,respectively).Type Ⅱ was further divided into Tpes Ⅱa and Ⅱb according to whether the course of injury was<or≥2 weeks,respectively.The mean post-operative flexion of the distal interphalangeal joint was 63.4°±7.9°,and the mean extension lag was 6.7°±4.6°.Conclusions:The lateral collateral ligament is the main factor that maintains the

关 键 词：CLASSIFICATION DISTAL interphalangeal JOINT Mallet FRACTURE SUBLUXATION 

分 类 号：R68[医药卫生—骨科学]