Patient satisfaction after hook plate treatment of bony avulsion fracture of the distal phalanges

Abstract

BackgroundBony avulsion fractures of the distal phalanges can result in mallet finger deformity if not treated appropriately. Therefore, only minimally displaced fractures can be treated conservatively with a good outcome, as dislocation occurs very often. Several surgical treatment options have been developed during the past decades. Data concerning the recently developed hook plate are promising. So far, no data concerning the subjective satisfaction with this method have been published. Therefore, we have analyzed the outcome after hook plate implantation using a self-assessment score, which focuses also on subjective parameters and satisfaction.MethodsStandardized questionnaires (self-assessment scores and SF-36 questionnaire) were sent to each patient treated with a hook plate due to fracture of the distal phalanx, type Doyle IVb and IVc. Clinical data were evaluated according to the medical record. Scores given per question range from 0 to 10, 10 is the worst and 0 the best outcome.ResultsFrom 69 patients treated, 38 (58%) were enrolled. The whole collective (n = 38) reached a score of 39.7 ± 28.7 points, while men had slightly better results. Men (n = 24) achieved 37.3 ± 27.9 points, women (n = 14) 43.9 ± 30.7 points. Women had significantly better results when analyzed later than 12 months after surgery (52.1 ± 27.9 vs. 29.1 ± 32.8), whereas no changes could be detected in the male group (37.1 ± 29.9 vs. 37.4 ± 27.6). Overall, men were slightly more satisfied than women. Most satisfaction was found regarding pain and fine motor skills (0–0.46 points). Esthetic aspect and nail deformities (3.65 points average) led to the highest dissatisfaction. No differences in the SF 36 score could be detected.ConclusionsThe hook plate is not only a convenient method but it also results in high patient satisfaction. Nail deformities are challenging; however, with increasing experience of the surgeon they decrease. SF 36 score is not an appropriate testing tool for this problem.Electronic supplementary materialThe online version of this article (10.1186/s40001-018-0332-y) contains supplementary material, which is available to authorized users.

A Bony Mallet Thumb with Interposition of the Nail Plate

“…The bony mallet thumbs can be surgically treated with tension band technique, pull-in suture, extension block pinning with one or two Kirschner wires, hook plate, screw, external fixation, compression pins, and biodegradable device. 9 In a recent study by Vester et al, treatment by hook plate technique was reported as a reliable and safe method to treat bony avulsion fractures of the distal phalanx, with high patient satisfaction. 9 But the esthetic aspects and the nail deformities are more challenging.…”

“… 9 In a recent study by Vester et al, treatment by hook plate technique was reported as a reliable and safe method to treat bony avulsion fractures of the distal phalanx, with high patient satisfaction. 9 But the esthetic aspects and the nail deformities are more challenging. 9 In our presented patient, however, no nail deformity occurred with the screw, which seemed to be due to the large size of the bony fragment with stable fixation and lack of damage to the germinal matrix.…”

“…Insufficient treatment may lead to extensor lag, early osteoarthritic changes of the DIP joint, or even a swan-neck deformity. 9 …”

“… 9 But the esthetic aspects and the nail deformities are more challenging. 9 In our presented patient, however, no nail deformity occurred with the screw, which seemed to be due to the large size of the bony fragment with stable fixation and lack of damage to the germinal matrix.…”

Clinical outcomes after mini-hook plate fixation for small avulsion fractures around the interphalangeal or metacarpophalangeal joints of the hand

“…First, the study was a retrospective comparative case series with a small sample size. Previous investigations [ 3 – 7 , 13 , 17 ] of mini-hook plate fixation were also retrospective case studies because the incidence of phalangeal avulsion fractures is relatively low, and there was insufficient evidence for planning a prospective study. A larger-scale, prospective study is necessary to support our results and obtain more outcome data.…”