Vol. 6, Issue 1, Part B (2024)

Background & Objectives: Mallet fractures, typically caused by direct trauma to the finger, involve the avulsion of the distal phalanx. Management strategies include Kirschner wire joystick (KWJ) and extension block pinning (EBP) techniques, each with benefits in stabilizing fractures and promoting healing. This study aimed to compare clinical outcomes, complications, and recovery between KWJ and EBP techniques for mallet fractures at Al-Yarmouk Teaching Hospital, Baghdad.
Methods: This retrospective study included 50 patients with acute mallet fractures treated with either KWJ or EBP between January 2021 and January 2023. Patients were randomly assigned to each technique, and data were collected from medical records. Key assessments included radiographic imaging and clinical evaluations (Using the Total Active Motion system and Crawford score) for joint congruency, functional recovery, and complications.
Results: Patients treated with KWJ had a greater range of motion (mean 72°) than those treated with EBP (mean 58°). The KWJ group also showed a shorter average operation time (30 minutes vs. 35 minutes for EBP) and a faster return to work (mean of 5 weeks for KWJ vs. 7 weeks for EBP). Complications were fewer with KWJ, with no cases of nail dystrophy, while EBP presented two cases. Both techniques had similar healing times (6 weeks). KWJ had a higher rate of "good" outcomes (65%) compared to EBP (50%), while "excellent" outcomes were comparable between groups.
Conclusions: KWJ provided superior range of motion, fewer complications, and quicker recovery times, making it a preferable technique for mallet fractures. These findings suggest that KWJ may be beneficial for patients requiring faster functional recovery. Further research is recommended to assess long-term outcomes and refine EBP techniques to minimize complications.