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Mallet fracture of ring finger in 60-year-old man. A, Preoperative simple radiograph showing fracture fragment involving more than 50% of articular surface. B, Intraoperative anteroposterior C-arm image. Using modified two-extension block technique, two parallel block wires inserted 2 mm apart. Note two parallel block wires prevent rotation of dorsal fragment in axial plane (yellow arrow). Red circle, fractured dorsal fragment. C, Intraoperative lateral C-arm image showing trial of closed reduction with traction and dorsal translation. Red arrow shows dorsal rotation of dorsal fragment in sagittal plane. D, Dorsal counterforce applied to dorsal fragment using 1.1-mm Kirschner wire. E, By applying dorsal counterforce to dorsal fragment, anatomic reduction with traction and dorsal translation of distal digit was achieved. Red arrow shows compressive force from volar side and yellow arrow shows dorsal counterforce by Kirschner wire. F, Due to large size of dorsal fragment, Kirschner wire used for dorsal counterforce was pushed into fragment for fixation. G, Postoperative anteroposterior radiograph. H, Postoperative lateral radiograph. Volar aluminum orthosis protects wire and limits excursion of extensors by blocking movement of distal interphalangeal joint.

出典

img 1:  From Lee SH, Lee JE, Lee KH, et al: Supplemental method for reduction of irreducible mallet finger fractures by the 2-extension block technique: the dorsal counterforce technique, J Hand Surg Am 2018 Nov. 5. Pii:S0363-5023(18)30406-4.