TREATMENT OF “MALLET FINGER” AND “MALLET FRACTURE” INJURIES
D.A. BUGAEV ¹, D. V. DEREVIANKO ²
Stavropol State Medical Academy, Stavropol, RUSSIA¹;
Municipal Budget Institution “City Hospital ¹1”, Novorossiysk, RUSSIA²
Introduction: treatment options for “mallet finger” and “mallet fracture” injuries continue to draw attention of hand surgeons for many years.
Aim of work is to reveal basic principles of treatment of concerned injuries.
Results: The most common mechanism underlying extensor tendon injury is a sudden flexion of a distal phalanx which is led to simple rupture of extensor apparatus, or avulsion fracture of the dorsal rim of the articular surface of a distal phalanx. All patients with suspicion of “mallet finger” and “mallet fracture” injuries are had to be X-rayed in spite of typical symptoms: inability to extend a distal interphalangeal joint and dropping of a distal phalanx. In accordance with X-ray pattern injuries are classified with J. R. Doyle or M. A. Wehbe & L. H. Schneider classifications. Conservative treatment with various types of orthoses, as it is experienced, is effective in the most cases of “mallet finger” and “mallet fracture” injuries. There is no however common opinion regarding deadline of the beginning of non-operative treatment. It is considered that the most optimal is to begin conservative treatment not later than two weeks after injury. Surgery is indicated if conservative treatment is unsuccessful, distal phalanx is subluxated, fracture involves more than one third of the articular surface or if there is unreductible displacement of a bone fragment. There are many methods of operative mallet finger management. It is mostly simple stabilization of a distal interphalangeal joint including transarticular fixation in hyperextension position and additional fixation of a bone fragment with Kirshner wire. Fundamental treatment feature of concerned injuries is permanent fixation of a distal interphalangeal joint in corrected position not less than 6 weeks followed by at least two weeks of night splinting and four weeks of splinting during exercises. It is also necessary to try to keep full range of motion in proximal interphalangeal joint.
Conclusion: character of concerned injuries and types of treatment do not require a patient to be hospitalized. Such injuries can be successfully treated in outpatient clinic. It gives possibility of rational using of financial resources, decreasing the risk of postoperative infection complications. It also helps to decrease social maladaptation of patients associated with necessity of twenty-four-hour being in a hospital.
SPLINT TYPE SELECTION IN “MALLET FINGER”
AND “MALLET FRACTURE” INJURIES MANAGEMENT
D.A. BUGAEV¹, D. V. DEREVIANKO²
Stavropol State Medical Academy, Stavropol, RUSSIA¹
Municipal Budget Institution “City Hospital ¹1”, Novorossiysk, RUSSIA²
Introduction: “Mallet finger” and “mallet fracture” injuries management is one of the actual hand surgery problems. Basic approach to both surgical and conservative treatment in concerned pathology is splinting.
Aim of work is to investigate peculiarities of splints of different types using for “mallet finger” and “mallet fracture” injuries treatment.
Results: application of commercial splints (Stack splint, Zimmer splint) leads to a problem of a splint to be fitted individually to a patient’s finger. In some cases it is possible with special pads and length size correction. Sometimes price of a device and its availability are needful to be taken into account both for a patient and a hospital. Aluminum strips dorsally or palmarly fixed to a finger with adhesive plaster are used for many years to make custom-molded orthoses. Aluminum custom-molded splints are not aesthetically accepted by all patients in comparison with commercial ones. Thermoplastic materials are quite widespread for splint-making. Workpieces for such splints are usually of “H, L, T or Ï” forms. Form fitting, low profile and well-tolerated by a patient are undoubted advantages of thermoplastic splints. Splintage however has some disadvantages irrespective of making technique. First of all it is possibility of uncontrolled taking off a splint by a patient what is led to treatment protocol violation and therapy failure. Casual splint slipping is also possible. The following complications of splintage are reported in literature: dorsal ulceration of a phalanx, allergies, fingernail deformities and skin maceration.
Conclusions: splint type selection and custom-molded splints making technique are important steps in “mallet finger” and “mallet fracture” injuries management. The most perspective way is to produce custom-molded splints of thermoplastic material. Patient compliance, finger skin hygiene and dynamic medical control for correct splint application are obligatory conditions herewith.
about s stratification of miocarcinoma of thyroid gland (MCTG)
Crimean State Medical University named after S.I.Georgiyev, Simpheropol, UKRAINE
The question on criterial of MCTG in the light of the Sixth revision of the classification UICC remains open, as the suggestion refers all tumors to 20 mm diameter to MC (T1) not taking into account the features of biology of carcinoma of TG and clinic prognostic data.
Aim of the investigation: to determine the difference at the initials for the patients suffering from differentiated carcinoma (DC) of TG, bunched according to the diameter of tumor.
Materials and methods: the investigation included retrospective analysis of 97 patients suffering from MCTG referred to T1 and T2 accordingly. The fifth edition of classification of TNM being treated from 1991 to 2003. M:W = 13:86. 64 patients suffer from papillary carcinoma, 33 patients suffer from follicular carcinoma. The patients were divided into three groups: group I – diameter of tumor till 10 mm, group II – 11-20 mm, group III – 21-40 mm. The criteria of assessment were the character of dissemination and 5 years survival potential after the operation. Average period of supervision was 8.6 year.
Results. Papillary carcinoma (PC). 19 patients (29,7%) - group I, 25 patients (39,1%) - group II, 20 patients (31,2%) - group III. Mean age of the patients of the first, the second and the third groups was 48,8±12,3, 44,7±14,5 è 47,4±16,0 age accordingly. Total thyreoidectomy was implemented at 19 (28,7%) out of 64 patients suffering from PC, hemithyroidectomy or hemithyroidectomy with resection of the second part or resection of different capacities was implemented at 45 (71,3%) out of them. Multi-focal growth was observed only at one out of 19 patients suffering from PMC and only one patient had metastasis in lymph nodes and one out of them had multi-focal growth with metastasis in lymph nodes. These patients were undergone to thyreoidectomy and it was supplemented by lymph dissection in the presence of metastasis. The rest 16 patients had unit tumors without metastasis. Intraoperative diagnosis was made at 3 patients, thyreoidectomy was implemented at three out of them, hemithyroidectomy at six out of them and resection of TG of different capacity at eight out of them. Repetitive operations were not carried out.
Metastases. Remote metastases were found during examination at one patient out of 63 patients suffering from PC. The size of the tumor of the patient was 18 mm (group II). Two patients of group I, eight patients of group II and 12 patients of group II had histologically acknowledged metastases in lymph nodes. Excluding the patients that were classified as Nx, frequency of metastases in cervical lymph nodes is considerably high in the groups II and III (32% and 60%) against 11% in group I.
Survival potential. No death was met in group I, but three patients of group II and four patients of group III died because of cancer. Statistically essential difference in survival potential between groups 1 and 2 (ð=0,033) and lack of difference between groups II and III was available. Local recurrence developed at one patient of group 1, he had remote metastases in the further examination. Recurrences developed at six patients of group II and eight patients of group III had
Follicle cancer (FC). 18 patients - group I, 10 - group II, 7 - group III. Mean age was 53,1±10,1, 44,3±16,4 and 44,1±18,4 age in groups I, II è III accordingly. Initial total thyreoidectomy (32,3%) or final thyreoidectomy (11.8%) was implemented at 15 out of 35 patients suffering from FC, resection of different capacities was implemented at 20 out of them.
Metastases. Remote metastases were not detected during examination. Cervical metastases in lymph nodes were found at three patients in group I and 2 patients in group II and 5 patients at group III.
Survival potential. 1 patient of group I, 3 patients of group II and 4 patients of group III died from FC. No local recurrence was detected in group I or prolongatio morbi in the process of supervision in group I, but recurrence developed at a patient of II group and 5 patients of III group.
Thus, there is no basis to refer all cancers of the size of 20 mm to T1, they require different therapeutic and tactical approach and data acknowledging adequacy of hemithyroidectomy for all MCTG of the size till 20 mm misses today. We consider micro-carcinoma of tumor till 10 mm right until enugh data is not collected for substantiated reconsideration from this point of view.