Percutaneous Blunt Needle Reduction (PBNR) Needs Stable Fixation
We read with great interest the manuscript titled “PBNR: percutaneous blunt needle reduction of bony mallet injuries” written by Miranda and colleagues. We want to express our views on some points.
Mallet finger is disruption of digit’s extensor mechanism from the basis of distal phalanx. Mallet fracture is avulsion of the extensor tendon and fracture of the dorsal rim of the articular surface of distal phalanx at the same time.1 If mallet finger deformity is neglected swan neck deformity and extension lag may develop.2
One third of all mallet fractures are associated with a fracture that involves the surface of distal phalangeal joint.3 Treatment options are divided into 2 groups: conservative or surgical. Surgical treatment indications are: fractures involving >33% of the articular surface and fractures with palmar subluxation of the distal phalanx that cannot be corrected by closed reduction.4,5 Extension block technique defined by Ishiguro et al6 is generally the most preferred surgical method for closed reduction of mallet fragment. They used first K wire to block the fragment at desired position and the second one to lock the joint.
Miranda et al7 described a similar technique. The difference of their technique from original one was that they have identified their technique to avoid the requirement for closed Ishiguro extension blocking wires or open fixation. They used a blunt needle, made a stab incision to reduce the fragment at operating room. Mallet fragment is very unstable, and it is hard to maintain the reduction because extensor tendon pulls the fragment. Our main criticism about their technique is that why they did not prefer to fixate this unstable fragment with K wire. A dorsal Zimmer splint is not superior to K wire fixation. We think PBNR represents a less-invasive but more risky to loose reduction management option for mallet finger.