الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
The indications for surgical treatment of bony mallet injuries include dorsal fracture fragments of more than one-third of the joint surface on the lateral radiograph or volar subluxation of the main remainder of the distal phalanx. Neglected displaced mallet fractures can cause extensor lag and swan neck deformity, and marked dysfunction if the distal phalanx dislocates.
Over a period of 2 years and 3 months, from April 2016 to July 2018, Seventeen patients with mallet fractures were treated by open reduction and internal fixation using the described hook plate technique at the trauma unit of the department of Orthopedics, Assiut University Hospitals. There were 11 men (64.7%) and 6 women (35.3%) with a mean age of 32.3±9.2 (range 18–
50) years. The fingers affected were three little fingers, five ring fingers, two middle fingers, six index fingers and one thumb finger. Five injuries were due to sport, three were road traffic accident, two were industrial and seven were domestic accidents. The average time from injury to operation was 6 (range1–
20) days.
The average percentage articular surface involvement was 48% (range 30– 65%). Out of the 17 patients included in this study, 6 cases were Wehbe Type IB and 11 cases were Wehbe Type IIB fractures. The average time from injury to operation was 12.1±5.2 (range1–20) days, While the average time from admission to surgery was6.59 ±2.24 (range4–12) hours. The average operative time was 37.65±5.97 (range 25-45) minutes. All cases were performed under local digital block.
The average follow-up was 10.94±6.16 (range 6–27) months. At last follow up visit, the average active range of flexion of the DIPJ was 50° (range 20°
–70°) and extensor lag was noted in 4 out of the 17 cases (23.5%). The mean extensor lag was 3° (range 0° to 20°).All seventeen fractures were united by 6 weeks after surgery, with congruent joint surfaces. Out of the 17 patients, 6 patients achieved excellent result (35.3%), 7 patients achieved good results (41.2%) and 4 cases achieved fair result (23.5%). No poor result was recorded in this study.
The overall complication rate in our study was 35.29% (6 out of the 17 cases). 2 of which were due to postoperative infection where metal removal and debridement was needed. Two cases suffered fracture re-displacement post hook plate fixation. Six cases (including the two cases of postoperative infection and the two cases of fracture re-displacement) were complicated by a nail deformity that was reversed on removal of the implant.
Although not mandatory, implant removal was planned for all cases in accordance with our local practice and at the time of thesis submission, this had been performed in all but two cases.
from the results of this study we concluded that the hook plate is a reliable and safe method for the treatment of bony avulsion fractures of the distal phalanx. it permit direct visualization and better anatomical reduction, control and stable fixation of the fracture. It allows early mobilization and early active movement of the DIPJ. Hook plate fixation avoids the complications of other surgical techniques( delayed union due to a poor reduction, delayed return to work or sports due to the discomfort from the wires, pin tract infection, marginal skin necrosis, recurrent and nail deformity). This technique is an outpatient procedure done under local digital block which add to its value as regards the patient safety and saving the resources.
We recommend sub-periosteal placement of the hook plate as this modification minimizes the nail deformity which is a common complication of this technique that was also reported in the other studies