The results of tenodermodesis for severe chronic mallet finger deformity in children

Abstract

BACKGROUND: The treatment of soft-tissue mallet fingers in children can be challenging because of delays in diagnosis and noncompliance with extension splinting or casting. The purpose of this investigation was to assess the results of tenodermodesis for the treatment of chronic soft-tissue mallet fingers in children. METHODS: A retrospective analysis of 10 patients younger than 18 years was performed. All had extensor lag greater than 45 degrees, absent active distal interphalangeal joint (DIPJ) extension, and full passive DIPJ motion. All patients had failed trails of nonoperative treatment. Tenodermodesis was performed using established techniques with 4 to 6 weeks of postoperative DIPJ immobilization. Patients were evaluated for active and passive DIPJ motion, deformity, pain, limitations in activities of daily living, and the need for additional treatment. Average age at the time of surgery was 7.4 years (range, 1.4-17.8 years). RESULTS: At average 6.5-year follow-up (range, 1-12.8 years), all patients demonstrated restoration of active DIPJ extension and improvements in extensor lag. Two patients (20%) achieved full active DIPJ extension, whereas 8 patients (80%) had persistent extensor lag of 20 degrees or less. Seven patients (70%) maintained full active DIPJ flexion. Eight (80%) of the 10 patients reported full return to activities with no limitations. No patients required additional surgical treatment for their mallet fingers. CONCLUSIONS: Tenodermodesis is a safe and effective technique for the treatment of severe chronic soft-tissue mallet finger deformities in children. Although patients and families should be advised of mild persistent extensor lag and limitations in DIPJ motion, active DIPJ extension and improved clinical appearance can be achieved with this procedure. LEVEL OF EVIDENCE: Level IV therapeutic. © 2008 Lippincott Williams & Wilkins, Inc.