JHS - 2026-03-19 - Journal Article
Repairing Chronic Tendinous Mallet Finger by Brachioradialis Tendon-Bone Graft.
Wang L, Guo B, Zhu H, Li X, Gu X
Topics
Key Takeaway
Brachioradialis tendon-bone graft reconstruction of chronic tendinous mallet finger achieved Crawford excellent or good outcomes in all 10 patients, with mean DIP active ROM of 82° at 3–5 year follow-up.
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Summary
This study evaluated brachioradialis tendon-bone graft reconstruction in 10 patients with chronic tendinous mallet finger (injury-to-surgery interval 3 months to 14 years) who failed nonsurgical management, including 2 with swan-neck deformity. The bone block was press-fit into a groove at the distal phalanx base, converting the repair interface from tendon-bone to bone-bone healing. Crawford criteria rated 4 excellent and 6 good; mean DIP active ROM was 82° with one minor complication (dorsal protuberance).
Key Limitation
The series of 10 patients with heterogeneous injury-to-surgery intervals (3 months to 14 years) and no comparative cohort makes it impossible to determine which patient subgroup benefits most or whether outcomes are superior to existing salvage techniques.
Original Abstract
PURPOSE
The management of chronic tendinous mallet finger resulting from extensor tendon insertion rupture presents a considerable challenge. To our knowledge, this study describes a clinical technique using a brachioradialis tendon-bone graft to reconstruct the extensor apparatus.
METHODS
Ten patients who remained unable to actively extend the distal interphalangeal joint despite nonsurgical treatment were included; of these, two demonstrated secondary swan-neck deformities. All patients demonstrated satisfactory passive range of motion in flexion and extension at the distal interphalangeal joint. Preoperative x-ray revealed no fractures involving the base of the distal phalanx. All surgeries took place between 3 months and 14 years after the initial injury. During the procedure, we inserted the graft's bone block into a prepared bone groove at the base of the distal phalanx and sutured the harvested brachioradialis tendon to the ruptured stump of the extensor tendon. This technique transforms the healing process at the extensor tendon insertion from tendon-bone healing to bone-bone healing.
RESULTS
The follow-up period ranged from 3 to 5 years. We assessed postoperative finger function using the Crawford criteria, rating four cases as excellent and six as good. We evaluated overall patient satisfaction using a Likert scale, with scores of 5 in 2 cases, 4 in 6 cases, and 3 in 2 cases. The mean active range of motion was 82°, ranging from 75° to 90°. Only one patient experienced a complication, a slight dorsal protuberance at the distal phalanx.
CONCLUSIONS
This technique is viable for reconstructing chronic tendinous mallet finger caused by extensor tendon insertion rupture.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.