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[The role of posterior bracket plate osteosynthesis in the treatment of compression-extension fractures of the distal end of the radius].

Osteosynthesis without immobilisation of compression-extension fractures by means of a posterior plate was studied in prospective series with a minimum follow-up of six months (first group: 73 patients) and a minimum follow-up of one year (second group: 63 patients). The clinical results were evaluated and showed several complications (no infection, but reflex sympathetic dystrophy, paresthesia, unsightly scars). The clinical and radiological findings (radio-ulnar index) could improve with several technical devices, now used.

Adolescent↗

Reduction of bone retropulsed into the spinal canal in thoracolumbar vertebral body compression burst fractures. A prospective randomized comparative study between Harrington rods and two transpedicular devices.

STUDY DESIGN: This was a prospective, randomized study. OBJECTIVE: To compare the ability of three methods of internal fixation (Harrington rods, AO internal fixator, posterior segmental fixator) to obtain reduction of intracanal fragments in thoracolumbar vertebral compression burst fractures. SUMMARY OF BACKGROUND DATA: Sixty-seven acute thoracolumbar compression burst fractures of T12 or L1 were randomized into three groups that were treated using one of the three methods. Reduction was accomplished indirectly by distraction applied using the fixation device. METHODS: The spinal canal encroachment was calculated as a percentage of the estimated pre-injury value from serial transverse computed tomographic scans obtained on admission and immediately after surgery. RESULTS: The median preoperative sagittal encroachment of the spinal canal was 37% (range, 0-90%) of the normal diameter. All three methods of internal fixation produced a spinal canal clearance provided that the patient was operated on within 4 days after trauma. The median postoperative encroachment varied from 13% (range, 0-37%) to 22% (range, 0-37%), the best reduction being attained using Harrington rods and the poorest with the posterior segmental fixator. There was a suggestive statistical significance between these two. CONCLUSION: The differences in postoperative spinal canal encroachment and ability to obtain spinal canal clearance observed between the devices studied were small. There seems to be no reason to base the choice of the operative method in thoracolumbar fractures on any hypothetical differences in reductive power between Harrington rods and the AO internal fixator.

Adolescent↗

Distraction external fixation in lateral compression pelvic fractures.

OBJECTIVE: To observe the results and describe the technique of closed reduction and placement of a two-pin supra-acetabular external fixator, followed by immediate weight bearing, in the treatment of displaced vertically stable lateral compression pelvic fractures. DESIGN: Prospective, consecutive SETTING: Regional trauma center PATIENTS: A consecutive series of fourteen patients with displaced, vertically stable lateral compression pelvic fractures who were transported to a regional trauma center. INTERVENTION: Surgical treatment with closed reduction and maintenance of the distraction force with a two-pin, single-bar, supra-acetabular external fixator, followed by immediate weight bearing. MAIN OUTCOME MEASUREMENTS: Healing rate and time, operative blood loss and time, quality of reduction, time to full weight-bearing, and incidence of complications, including neurovascular deficits, loss of reduction, nonunion, pin tract infections, and chronic pain. RESULTS: A symmetric reduction of both hemipelves was achieved in all fourteen patients. Time to healing averaged 8.2 weeks (seven to twelve weeks), and no fixator required removal before healing. There were no delayed unions or nonunions, and none of the fractures displaced significantly after initial reduction. Average surgical time was thirty-seven minutes (range, twenty-five to sixty minutes) with an estimated blood loss of less than fifty milliliters. Patients were allowed to bear full weight immediately and were able to do so without ambulatory assistive devices within an average of twelve days (range, three to eighteen days). Complications consisted of three minor pin tract infections, one temporary lateral femoral cutaneous nerve palsy, one late pin tract abscess, and one patient with chronic low-back pain. CONCLUSIONS: Treatment of type B lateral compression injuries of the pelvic ring with anterior distraction external fixation is a highly effective yet relatively simple and minimally invasive treatment method. Surgical time and blood loss are minimal, and patients can be effectively and rapidly mobilized. Based on our experience, we believe this method to be a valuable tool in the treatment of these fractures.

Adolescent↗

Distraction external fixation in lateral compression pelvic fractures.

OBJECTIVE: To observe the results and describe the technique of closed reduction and placement of a two-pin supra-acetabular external fixator, followed by immediate weight bearing, in the treatment of displaced vertically stable lateral compression pelvic fractures. DESIGN: Prospective, consecutive. SETTING: Regional trauma center. PATIENTS: A consecutive series of fourteen patients with displaced, vertically stable lateral compression pelvic fractures who were transported to a regional trauma center. INTERVENTION: Surgical treatment with closed reduction and maintenance of the distraction force with a two-pin, single-bar, supra-acetabular external fixator, followed by immediate weight bearing. MAIN OUTCOME MEASUREMENTS: Healing rate and time, operative blood loss and time, quality of reduction, time to full weight-bearing, and incidence of complications, including neurovascular deficits, loss of reduction, nonunion, pin tract infections, and chronic pain. RESULTS: A symmetric reduction of both hemipelves was achieved in all fourteen patients. Time to healing averaged 8.2 weeks (seven to twelve weeks), and no fixator required removal before healing. There were no delayed unions or nonunions, and none of the fractures displaced significantly after initial reduction. Average surgical time was thirty-seven minutes (range, twenty-five to sixty minutes) with an estimated blood loss of less than fifty milliliters. Patients were allowed to bear full weight immediately and were able to do so without ambulatory assistive devices within an average of twelve days (range, three to eighteen days). Complications consisted of three minor pin tract infections, one temporary lateral femoral cutaneous nerve palsy, one late pin tract abscess, and one patient with chronic low-back pain. CONCLUSIONS: Treatment of type B lateral compression injuries of the pelvic ring with anterior distraction external fixation is a highly effective yet relatively simple and minimally invasive treatment method. Surgical time and blood loss are minimal, and patients can be effectively and rapidly mobilized. Based on our experience, we believe this method to be a valuable tool in the treatment of these fractures.

Acetabulum↗

Vertebroplasty and kyphoplasty.

Vertebroplasty and kyphoplasty are relatively new techniques used to treat painful vertebral compression fractures (VCFs). Vertebroplasty is the injection of a vertebral body with bone cement, generally polymethylmethacrylate (PMMA). Kyphoplasty is the placement of balloons (called "tamps") into the vertebral body with an inflation/deflation sequence to create a cavity prior to the cement injection. These procedures are most often performed in a percutaneous fashion on an outpatient (or short stay) basis. The mechanism of action is unknown, but is postulated that stabilization of the fracture leads to analgesia. The procedure is indicated for painful vertebral compression fractures due to osteoporosis or malignancy, and painful hemangiomas. The procedure may have efficacy in painful vertebral metastasis and traumatic compression fractures. Much evidence favors the use of this procedure for pain associated with these disorders. The risks of the procedure are low but serious complications occur. The risks include spinal cord compression, nerve root compression, venous embolism, and pulmonary embolism including cardiovascular collapse. The risk/benefit ratio appears favorable in carefully selected patients. The technical aspects of the procedures in presented in detail along with patient selection. A comprehensive review of the evidence for the procedure and its reported complications is presented.

Journal Article↗

Functional results of vertebral augmentation techniques in pathological vertebral fractures of myelomatous patients.

INTRODUCTION: This is a retrospective study to determine the effects of vertebroplasty and kyphoplasty on quality of life in multiple myeloma patients with spinal compression fractures. MATERIAL AND METHODS: Thirty-four patients with primary multiple myeloma were treated for symptomatic compression fractures between June 2003 and June 2005. Kyphoplasty was applied to 22 levels in 18 and vertebroplasty to 28 levels in 16 patients. The pain-related disability was evaluated for every single daily living activity using visual analog scale (VAS) over 10 points. (pain at rest, walking, sitting-standing, taking a shower and wearing clothes). (This evaluation is performed to every patient with degenerative disorders of the spine upon admission to our clinic.) Overall VAS scores were evaluated over 50 points (0 minimum, 50 maximum) preoperatively, at postoperative six weeks, six months and at one year prior to taking analgesics. The amount of analgesic use was recorded. Data was analyzed statistically using variance analysis, Friedman's multiple comparison test and Student's t test. RESULTS: The mean overall pain score in the kyphoplasty group decreased from a preoperative value of 36 to 12.13 at the sixth postoperative week, to 8.63 at the sixth month and to 9.72 at one year. (p<0.001). The mean overall pain score in the vertebroplasty group decreased from a preoperative value of 37.83 to 15.33 at the sixth postoperative week, to 12.17 at sixth months and to 13.47 at one year. (p<0.001). Student's t test was used to analyze the percentage of differences in overall pain score. Difference between groups was not statistically significant at the sixth week (p=0.106) but was statistically significant both at the sixth month (p=0.024) and at one year (p=0.027) in favor of kyphoplasty group. No secondary collapse was observed in adjacent levels in both groups. There were no intrapostoperative neurologic/pulmonary complications in both groups. Analgesics usage significantly decreased in both groups. CONCLUSION: In multiple myeloma, when pathological spinal compression fractures cause intractable pain and are unresponsive to conservative treatment, both vertebroplasty and kyphoplasty are effective in increasing quality of life and decreasing pain.

Aged↗

Vertebral osteonecrosis: MR imaging findings and related changes on adjacent levels.

BACKGROUND AND PURPOSE: No prior report has comprehensively discussed the intravertebral vacuum cleft sign and the fluid sign on MR images of vertebral osteonecrosis. The purpose of this study was to investigate MR images of osteonecrotic vertebral bodies and adjacent intervertebral disks and vertebral bodies. METHODS: We retrospectively reviewed MR images of patients with vertebral osteonecrosis. Affected vertebral bodies with osteonecrosis were defined as an avascular area (nonenhanced area on enhanced T1-weighted images) with collections of intravertebral fluid (hyperintense signal on T2-weighted images), air (signal void on all images), or both. The degree of vertebral collapse was classified as mild (>50%) or severe (<50%) preserved vertebral height. Changes in adjacent intervertebral disks or vertebral bodies 2 above and 2 below the affected vertebrae were compared. RESULTS: We enrolled 112 patients (30 men, 82 women; 121 vertebral bodies) in our study. Intravertebral air alone was observed in 48 involved levels (39.7%), intravertebral fluid alone was found in 47 (38.8%), and both coexisted in 26 (21.5%). Degree of vertebral collapse in affected vertebral bodies significantly differed with presence of air or fluid (P < .05). Vertebral compression fractures adjacent to the affected vertebral bodies were more common in those with intravertebral air alone than in those with intravertebral fluid alone (P < .05). CONCLUSION: Vertebral collapse was more advanced and adjacent vertebral compression fractures were more frequent in patients with intravertebral air than in those with intravertebral fluid.

Aged↗

[The contrast study between single and double balloon bilateral dilatation of kyphoplasty].

OBJECTIVE: To contrast single and double balloon-inflated kyphoplasty for vertebral compression fractures (VCFs) and evaluate its clinical efficacy. METHODS: From May 2000 to May 2004, 90 consecutive procedures were performed in 58 patients who suffered from painful vertebral compression fractures, transferring tumour and angioma. Ninety vertebrae were inflated while 62 as A group were double balloon and 28 as B group were single balloon, fracture reduction and bone cement augmentation. Preoperative and postoperative symptom levels, variables, complications were recorded and the vertebral height and Cobb angle were measured and analyzed. RESULTS: All patients' pain was alleviated or disappeared without syndrome, and the vertebral height and Cobb angle of both groups were improved. The average recovery rate was 72.6% (22.9% approximately 100%), Cobb angle from 17.9 degrees (3.1 degrees approximately 31.6 degrees ) were corrected to 9.6 degrees (0.6 degrees approximately 28.2 degrees ), the average angle was 8.7 degrees (0.3 degrees approximately 27.2 degrees ), and the contrast between preoperative and postoperative showed obvious differences (P <0.001). The average recovery rate of A group was 77.6% (55.3% approximately 100%), B group was 64.3% (22.9% approximately 100%). The average postoperative Cobb angle of A group was 9.9 degrees (0.3 degrees approximately 27.2 degrees ), B group was 8.6 degrees (0.6 degrees approximately 19.8 degrees ) (P >0.05). CONCLUSIONS: As a promising minimally invasive surgery, balloon kyphoplasty can provide early relief of pain and improve the function as well as spinal alignment in treatment of painful compression fracture owing to recovering the vertebral height and Cobb angle of the vertebral body. Single balloon-inflated kyphoplasty can improve VCFs as double balloon.

Adult↗

Multilevel Revision Percutaneous Vertebroplasty in Elderly Patients With Osteoporotic Thoracolumbar Fractures: A Retrospective Cohort Study.

PURPOSE: Vertebral compression fractures (VCFs) are common complications of osteoporosis in elderly patients. Percutaneous vertebroplasty (PVP) provides pain relief and functional improvement, but some patients require revision due to refracture, cement failure, or new symptomatic levels. While outcomes of primary and multilevel augmentation have been described, systematic data on multilevel revision PVP remain rare. The aim of this study was to evaluate pain relief, functional improvement, and perioperative safety after three- and four-level revision PVP in elderly patients with osteoporotic thoracolumbar fractures. METHODS: This retrospective, single-center cohort included patients aged 75-85&#x2009;years who underwent revision PVP between August 2019 and November 2023. Eligible cases had a history of prior PVP and required repeat augmentation of three or four vertebral levels in a single session. Visual Analogue Scale (VAS) scores for pain and Oswestry Disability Index (ODI) for functional disability were recorded preoperatively and at 1-, 3-, 6-, and 12-month follow-up. RESULTS: Nine patients were analyzed. Revision involved three levels in five patients and four levels in four patients, with a mean interval of 14.1&#x2009;months after the index procedure. Mean VAS improved from 8.3&#x2009;&#xb1;&#x2009;0.7 preoperatively to 3.2&#x2009;&#xb1;&#x2009;0.6 at 12&#x2009;months (61% reduction, p&#x2009;<&#x2009;0.01). ODI improved from 75.2%&#x2009;&#xb1;&#x2009;3.4% to 26.9%&#x2009;&#xb1;&#x2009;2.7% (64% reduction, p&#x2009;<&#x2009;0.01). All patients exceeded the minimal clinically important difference thresholds. No perioperative complications such as cement leakage, neurological deficits, or pulmonary events were observed. CONCLUSION: Three- and four-level revision PVP provided significant pain relief and functional improvement in elderly patients with osteoporotic fractures, without increased complication rates. To our knowledge, this represents one of the first reports addressing this topic, suggesting it is an effective option in carefully selected patients.

Humans↗

Vertebroplasty in the treatment of back pain.

PURPOSE: The aim of this study is to show the utility of vertebroplasty in the treatment of some types of back pain. Vertebroplasty is a venous embolisation of the vertebral body performed under computed tomography (CT) or fluoroscopy guidance with transpedicular, anterolateral, intercostovertebral or posterolateral approach with acrylic cement. MATERIALS AND METHODS: We report our experience in 85 patients suffering from low back and thoracic pain and treated with percutaneous vertebroplasty owing to osteoporotic vertebral compression fractures, vertebral haemangiomas or secondary lytic lesions of the spine. Patient selection was performed on the basis of physical examination, magnetic resonance or less frequently, with bone scan. CT has a minor role in selected cases to evaluate the integrity of the posterior wall. We treated 55 patients affected by acute osteoporotic vertebral compression fracture, 10 patients with vertebral haemangioma and 20 patients with metastatic lesions. The patients were placed in the prone position and the procedure was performed under fluoroscopy guidance in 80 patients and under CT guidance in 5 patients affected by metastatic lesions. In no cases was phlebography performed before the treatment. The approach adopted was bilateral in 45 patients and unilateral in the remaining 30 cases. Injection with a low viscosity cement was performed under fluoroscopy guidance with extreme precision in all cases. The amount of cement injected ranged from 4 ml (thoracic level) up to 12 ml (lumbar level). RESULTS: The results were better for osteoporotic cases (95%) and patients with vertebral haemangioma (90%) than with metastatic lesions (77%), with improvement within 24-72 hours after the treatment. We noted asymptomatic cement leakage in 39 cases but only in 2 cases was there an acute radiculopathy due to epidural cement leakage, which was treated and resolved medically in 1 month. At follow-up no cases were noted of fractures of vertebral bodies adjacent to the treated vertebrae. DISCUSSION AND CONCLUSIONS: Since the first case of vertebroplasty was used in vertebral haemangioma, the possibility of using this technique in other pathological conditions such as metastatic lesions and osteoporotic compression fractures has been clear. MR has a key role in the selection of patients while bone scan and CT can be useful in selected cases. Absolute controindication is local or systemic infection while relative controindications are epidural extension of the neoplastic lesion, vertebra plana, clinical signs of myelopathy or radiculopathy and coagulation disorders. The results of our study were better in patients treated for osteoporosis or haemangioma than in cancer patients. We consider percutaneous vertebroplasty a valid technique for the treatment of the pain due to osteoporotic compression fractures, vertebral haemangiomas or metastatic lesions.

Back Pain↗

Repair of mandibular fractures via compression plating and more traditional techniques: a comparison of results.

To evaluate the results of compression plating in the repair of mandibular fractures, a retrospective analysis of mandibular fractures repaired at Upstate Medical Center in the past 3 years was performed. Only patients treated as inpatients were included. A total of 68 cases were reviewed, and follow-up data were available in 59. Of these, 18 had been repaired using A-O compression plating techniques, and the remaining 41 were treated using interosseous wiring, intermaxillary fixation, external fixation, soft diet, or any combination of these. Nonunion and malocclusion were considered major complications, while all other complications were considered minor. Using these criteria, there were no major complications in fractures treated with compression plates, and there were 6 minor complications in 4 patients (22% of patients). Using the more traditional techniques, there were 13 major complications, 6 malocclusions and 7 non-unions, or an incidence of 32%, and 5 minor complications in 4 patients (10% of patients). These findings suggest that compression plating is a useful and highly effective technique for repair of mandibular fractures. The technique generally obviates intermaxillary fixation and dental splints, particularly in the edentulous patient. The main disadvantage is the need for 2 open procedures.

Adolescent↗

Stress fractures of the femoral neck in child with open capital femoral epiphysis.

Stress fracture of the femoral neck has been considered a typical injury of two age groups: active youths and elderly people with osteoporosis. Its occurrence in children with an open capital femoral epiphysis is rare, and only 11 cases have been reported. Here we report two cases, in a 12-year-old boy and a 5-year-old girl (among the youngest patients on record). This fracture can be classified as a compression fracture or a tension fracture. Although tension fractures are not uncommon in military recruits and young athletes, all 13 cases (including our two cases) of femoral neck stress fracture associated with an open capital epiphysis were compression fractures that were treated conservatively.

Child↗

"SKyphoplasty": a single institution's initial experience.

PURPOSE: The treatment of painful compression fractures has been revolutionized by vertebroplasty and kyphoplasty, two recently developed techniques that continue to evolve. This article describes a new device for the performance of kyphoplasty that uses a polymer device rather than a balloon to create a void in the bone. MATERIALS AND METHODS: In nine consecutive patients, kyphoplasty was performed at 12 vertebral levels with osteoporotic compression with use of the new SKy bone expander polymer device. RESULTS: The device was successful in creating a void in the bone at all levels. The procedure was also effective in alleviating pain from compression fractures. There were no technical failures or complications. CONCLUSION: The SKy bone expander polymer device is effective and safe for the performance of kyphoplasty to alleviate pain from vertebral compression fractures.

Aged↗

Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate: a case report.

STUDY DESIGN: A case report and review of the literature are presented. OBJECTIVE: To present the first case of paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate in osteoporotic compression fracture. SUMMARY OF BACKGROUND DATA: Complications of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for the treatment of osteoporotic compression fracture were found to be rare and minor, except in two cases of major neurologic complication. METHODS: The reported case is that of a 66-year-old woman with multilevel vertebral osteopenia and compression fractures. Percutaneous vertebroplasty using polymethylmethacrylate was performed at three vertebral bodies (L2, L1, and T11) using careful techniques including venography, large cannula, proper preparation and amount of polymethylmethacrylate, and continuous visualization with fluoroscopy. RESULTS: Immediately after surgery, the patient had complete motor and sensory deficits at T11. Computed tomography scan showed spinal cord compression caused by venous leakage of polymethylmethacrylate. In anticipation of recovery from paraplegia, posterior decompression was performed from L2 to T10. CONCLUSIONS: Percutaneous vertebroplasty with polymethylmethacrylate is not as simple and risk free as advocated in the literature. Careful safeguards and modifications are needed for the procedure, and new and physiologic material could be substituted for polymethylmethacrylate.

Aged↗

Quality of life following vertebroplasty.

BACKGROUND: Percutaneous vertebroplasty may be indicated when a patient with a painful osteoporotic vertebral compression fracture remains intolerably symptomatic in spite of comprehensive, nonoperative management. Relief of pain and quality of life following percutaneous vertebroplasty, however, remain incompletely defined. We investigated these outcomes with use of a visual analog scale and a validated, osteoporosis-specific health-related quality-of-life instrument. METHODS: We performed a prospective study of consecutive patients who underwent percutaneous vertebroplasty. At the time of enrollment, all patients completed the Osteoporosis Quality of Life Questionnaire, a validated thirty-item, five-domain, 7-point response-option instrument that measures health-related quality of life in osteoporotic women with back pain due to vertebral compression fracture. At two weeks, two months, and six months postoperatively, all patients completed a validated extraction of the Osteoporosis Quality of Life Questionnaire. The minimal, clinically important difference in this 7-point scale is 0.5 unit per question. To assess pain, a visual analog scale (ranging from 1 to 10) was completed preoperatively, one day postoperatively, and at each evaluation thereafter. RESULTS: Forty-six consecutive patients (thirty-two women and fourteen men) underwent forty-nine percutaneous vertebroplasty procedures for the treatment of sixty-six vertebral compression fractures. The mean age of the patients was 74.3 years. The mean fracture age was 2.5 months. The mean pain rating decreased from 7.7 preoperatively to 2.8 one day after the vertebroplasty (p < 0.001), and it remained substantially improved at two weeks, two months, and six months postoperatively (p < 0.001). All five domains of the Osteoporosis Quality of Life Questionnaire were improved at two weeks postoperatively and remained improved at each evaluation point through six months (p </= 0.007). Multivariate analysis demonstrated no consistent correlation between postoperative pain relief or any postoperative Osteoporosis Quality of Life Questionnaire domain score and gender, smoking history, previous or current steroid use, bone mineral density, dynamic mobility, or the presence of an intravertebral cleft. Immediate postoperative pain relief was weakly and positively associated with age (p < 0.03). Four incident vertebral compression fractures occurred in three (6.5%) of the forty-six patients, and five patients died within six months after the vertebroplasty. No deaths or serious adverse events appeared to be related to vertebroplasty. CONCLUSIONS: Rapid and substantial relief of pain and improvement in the quality of life are observed following percutaneous vertebroplasty, and these improvements are maintained for at least six months. Percutaneous vertebroplasty can be performed safely in frail, elderly patients, with no apparent increase in the incidence of fractures postoperatively. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗

Spring alloplasty in the treatment of fractures of the thoracic and lumbar spines. A correlation of the results of treatment with the mechanism of injury.

We describe 270 patients with spinal injuries who were treated by spring alloplasty between 1971 and 1985. The radiological results were compared with the mechanism of injury. The best outcome was obtained in patients with a spinal dislocation or flexion fracture. The technique is also recommended in compression fractures with wedging of the vertebral body, where there is a smaller proportion of good radiological results, but a gratifying improvement in neurological and functional outcome. The method is only cautiously advocated in cases of facet joint fracture and is generally contraindicated in massive compression fractures.

Fractures, Bone↗

Undetected posttraumatic instability of "stable" thoracolumbar fractures.

A review of 106 consecutive patients who had operative stabilization of thoracolumbar fractures revealed that 16 patients had surgery 4 months to 13 years after injury, for chronic instability. In these 16 patients, there were 8 wedge-compression fractures, 6 flexion-distraction injuries, 1 burst fracture, and 1 fracture-dislocation. All six patients with flexion-distraction injuries and the two patients with either a burst fracture or a fracture-dislocation had good results. Only two of the eight patients with wedge-compression fractures had good results. We concluded from this study that: (a) instability that presents without a progressive spinal deformity may go unrecognized; (b) all types of spine fractures can produce chronic, painful instability; and (c) poor results predominate in wedge-compression fractures operated more than 13 months after injury, regardless of the type of surgical treatment rendered.

Adolescent↗

Treatment of mallet fractures using compression fixation pins.

Fifteen patients who underwent percutaneous fixation of mallet fractures of the distal phalanx using compression fixation pins were assessed. Anatomical reduction was achieved in all patients. There were no nonunions. The mean active range of motion of the distal interphalangeal joint was 1 degrees of hyperextension to 69 degrees of flexion. The fixation was stable enough to allow early active motion exercise of the distal interphalangeal joint. This technique results in a good range of motion in a shorter period of time than other treatments.

Adolescent↗