Journal of Musculoskeletal Trauma

Percutaneous Kirschner-wire fixation followed by an opencast to permit protected daily and sports activities in patients with tendinous mallet finger: a case series at a tertiary hospital in Korea: Hyeon Jun Kim, Ji Woong Kim, Min Kyun Cho, Sung Yoon Jung; J Musculoskelet Trauma 2026;39(4):354-364. Published online October 20, 2026; DOI: https://doi.org/10.12671/jmt.2026.00269

Abstract PDF: Background
Dong-A University Hospital’s protocol for tendinous mallet finger requires 12 weeks of continuous full-time distal interphalangeal (DIP) joint splinting, which may restrict activities and complicate hygiene. This study evaluated the feasibility, short-term safety, and 6-month clinical outcomes of buried Kirschner-wire fixation followed by opencast application.
Methods
This retrospective case series screened 36 patients with mallet finger between January 2024 and October 2025. Twelve met the exclusion criteria, leaving 24 eligible patients; eight elected nonoperative treatment, and 16 chose surgery for acute closed tendinous mallet finger and constituted the study cohort. The DIP joint was fixed in approximately 15° of hyperextension using one or two buried 1.1-mm Kirschner wires. An opencast was applied at 1 week. The wires were routinely removed and active motion was initiated at 8 weeks, followed by a removable brace during outdoor or sports activities for 4 weeks. Outcomes were evaluated at 6 months.
Results
The mean preoperative extension lag was 30.0°. At 6 months, the mean residual extension lag was 1.9°, no flexion loss was observed, and Crawford outcomes were excellent in 62.5% and good in 37.5%. Two superficial pin-site infections resolved with oral antibiotics and local wound care. A separate case of wire loosening with painful subcutaneous prominence was managed with an aluminum splint. All patients resumed daily activities and showering at 1 week, when protected sports were also permitted; exact return dates and activity intensity were not recorded.
Conclusions
Buried Kirschner-wire fixation followed by opencast application may be an option for selected patients who wish to avoid prolonged full-time splinting. The protocol permitted protected activities from week 1 and active DIP motion from week 8; these findings support its feasibility but do not establish earlier return to unrestricted activity. Level of evidence: IV.

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The Result of the Modified Extension Block Technique in Bony Mallet Finger: Seung Rim Yi, Sung Ho Hahn, Bo Kyu Yang, Yang Joon Ahn, Jae Hoo Yoo, Yong Beom Yeo, Sung Woo Bin; J Korean Fract Soc 2006;19(2):236-240. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.236

PURPOSE
To evaluate the treatment outcomes of the modified extension block technique for bony mallet finger.
MATERIALS AND METHODS
This study included 16 patients who had been treated with the modified extension block technique for bony mallet finger from December 2002 to January 2004. The average duration of follow up was 13 (12~17) months. The indication of operation was the presence of a large bony fragment invading more than 1/3 of the articular surface or the palmar subluxation in the distal interphalangeal joint.
RESULTS
The average extension lag was 2.3 degrees, and the range of motion of the distal interphalangeal joint was 68.8 degrees. Radiograph showed bony union state in all cases. By the Crawford's evaluation criteria, 12 cases (75%) was excellent or good. Postoperative complications occurred in 3 cases, which were reduction loss within postoperative 2 weeks in 2 cases and mild pain with motion in 1 case.
CONCLUSION
The modified extension block technique is a easy and simple method. It shows a good result without complications from skin incision. So, it seems a useful method for bony mallet finger.

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Percutaneous Kirschner Wire Fixation of Acute Mallet Fractures Percutaneousely Reduced by Towel Clip
Chung Soo Han, Duke Whan Chung, Bi O Jeong, Hyun Chul Park, Jin Young Kim, Cheol Hee Park, Jin Sung Park
Journal of the Korean Fracture Society.2009; 22(4): 283. CrossRef

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Treatment of Bony Mallet Finger: Closed Reduction Using Extension Block K-wire: Jae Yeol Choi, Hwa Jae Jung, Ho Jin Lee, Kyung Mo Son, Young Hun Kim; J Korean Fract Soc 2004;17(4):362-367. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.362

Abstract PDF

PURPOSE
To review the result of bony mallet finger treated with a closed reduction using extension block K-wire MATERIALS AND METHODS: Between January 2001 and November 2002, among the patients with bony mallet finger underwent closed reduction using extension block K-wire, we retrospectively reviewed 14 patients with 14 fractures who had a minimum follow-up of 12 months.
RESULTS
There were 10 men and 4 women, with an average follow-up for all cases 15.7 months (range, 12 months~18 months). According to Crawford's evaluation criteria, we obtained 7 excellent, 5 good, 2 fair. We obtained bony union in all patients, with no remained pain. The average ROM was 67 degrees at postoperative 12 months. Postoperative complications occurred in two cases, which were nail deformity and mild osteoarthritis at the distal interphalangeal joint. There was no pin site infection.
CONCLUSION
This technique is not only easier but also less invasive than other techniques for reduction of mallet finger. Also, it shows excellent result with lower complication rate. So, it seems a reliable treatment for bony mallet finger.

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Osteoarthritis after Extension Block Technique for the Bony Mallet Finger
Sung Hoon Koh, Jung Hyun Park, Jin Soo Kim, Si Young Roh, Kyung Jin Lee, Dong Chul Lee
Archives of Hand and Microsurgery.2021; 26(4): 238. CrossRef
Comparison of Surgical Outcomes of Percutaneous K-Wire Fixation in Bony Mallet Fingers with Use of Towel Clip versus 18-Gauge Needle
Ho-Seung Jeon, Chan-Sam Moon, Seo-Goo Kang, Kyeong-Seop Song, Uk-Hyun Choi
Journal of the Korean Society for Surgery of the Hand.2013; 18(1): 1. CrossRef
Percutaneous Kirschner Wire Fixation of Acute Mallet Fractures Percutaneousely Reduced by Towel Clip
Chung Soo Han, Duke Whan Chung, Bi O Jeong, Hyun Chul Park, Jin Young Kim, Cheol Hee Park, Jin Sung Park
Journal of the Korean Fracture Society.2009; 22(4): 283. CrossRef

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A Comparision of conservative and Operative Treatmene in the Bony Mallet Finger: Ik Su Choi, Su In Roh, Hong Ju Ha, Jin Goo Kang, Dae Yeon Kim; J Korean Soc Fract 1999;12(4):1021-1026. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1021

Abstract PDF

Mallet finger is a commom deformity caused by disruption of the extensor mechnism at the dorsal base of the distal phalanx. Patients can by managed by either conservative or operative treatment depending on some factors, such as the fracture type and interval from injury to medical treatment. However, whether to perform conservative or operative treatment is in debate. We conducted this study to compare the results of conservative and operative treatment of mallet finger caused by intra-articular fracture of the distal phalanx, with not mere than one third of the articular surface of the distal phalanx involved. From March 1994 to April 1999, we experienced 26 cases of bony mallet fingers. Following are the results. 1. The result by Kanies scale was satisfactory in 9 cases of 12 in conservative treatment(75%), and 10 cases of 14 in operative treatment(71%)(P>0.05). 2. The result was satisfactory in 8 cases of 10 in patients who were treated within 2 weeks(80%), and 4 cases of 7 in those treated after 4 weeks(57%)(P<0.05). 3. Conservative treatment was more cost effective, easier to perform compared to operative treatment. Thus, we suggest conservative treatment as the better treatment method for bony mallet finger with ont more than one third of the articular surface of the distal phalanx involved.

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Surgical versus conservative management of Doyle type 4c mallet finger: a comparative study
Hakan Ertem, Enes Gündüz, Ayşe Şencan, Ethem Ayhan Ünkar, Osman Orman
BMC Musculoskeletal Disorders.2026;[Epub] CrossRef
Extension pin block technique versus extension orthosis for acute bony mallet finger; a retrospective comparison
Gurkan Gumussuyu, Mehmet Melih Asoglu, Olcay Guler, Hasan May, Adil Turan, Ozkan Kose
Orthopaedics & Traumatology: Surgery & Research.2021; 107(5): 102764. CrossRef

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