الفهرس 
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Abstract
Mallet finger is a traumatic lesion of the terminal extensor band in zone 1, characterized by division of the tendon insertion alone (Tendinous mallet) or an avulsion of the articular surface of the distal phalanx (Bony mallet) . (1) (16)
Segond described the first bony mallet finger in 1880 and Schoening described the first tendinous mallet finger in 1887. (5)
Mallet finger lesions are common, with a prevalence of 9.3% of all tendon and ligament lesions in the body and an incidence of 5.6% of all tendinous lesions in hand and wrist. (6) High-energy mechanisms of injury are more common in young males and low-energy mechanisms of injury are common in elderly females. (7)
Although specific biomechanical studies have not declared the mechanism of injury in mallet finger, several theories have been proposed. The process is divided into two steps by all researchers. The first step is the application of an axial force to the distal end of a straight finger. The second step varies among authors, some have argued that the axial force is followed by extreme passive DIPJ hyperextension this explains bony mallet injuries. (4) (76) Others have proposed that the axial force is followed by extreme passive DIPJ hyperflexion, which explains tendinous mallet fingers (12) other researchers have suggested that the resistance of the Oblique retinacular ligament fibers determines tendon or bone avulsion. (83) None of these theories have been proven.
The diagnosis of mallet finger is essentially clinical. The patient’s recent history usually includes the likely mechanism of injury. The patient typically presents in an emergency setting or seeks care later, sometimes several weeks after the injury. The patient usually complains of pain and of being unable to perform full active extension of the DIPJ. Upon examination, a passively reducible mallet deformity, swelling, and/or ecchymosis of the dorsal aspect of the DIPJ is found. Fingertip rests at 45°of flexion. Pressure is painful. (14)
A systematic radiographic lateral and anteroposterior study of the DIPJ usually see bony avulsion of distal phalanx or it may be a ligamentous injury with normal bony anatomy, Wehbe and Schneider (15) described a method to measure the size and displacement of the bony fragment. Clinical examination and standard radiographs are sufficient to establish a diagnosis.
Doyle’s classification (35) considers the anatomical lesion and the size of the fractured bone fragment, and includes tendinous mallet and open lesions. It does not correlate bone fragment size with volar subluxation. The sizes of the bony fragment that determine the subtype are 20% and 50% of the articular surface.
Treatment of mallet finger remained a great challenge for surgeons. Proper training is needed to adopt recent advances to deal with this challenge. There are various treatment modalities for the management of mallet finger including hyperextension of DIP joint and orthosis, closed reduction with percutaneous pinning and open reduction and internal fixation.
Various surgical techniques for displaced mallet fractures, such as K-wire pinning (72), pull-out wiring (65) (70) (71), compression pin fixation (64), hook plate fixation, and microscrew fixation (84) have been described.
Our present study was conducted 20 adult patients with mallet finger (Doyle type I) were managed in the department of Orthopedics, Sohag university hospital from February 2019 to November 2019 to compare between conservative versus surgical treatment of acute mallet finger. 20 of them managed conservatively by aluminum orthosis, and the other 20 were managed surgically by a single k-wire fixation. Patients fulfilling the inclusion criteria. Follow up all patients in this study was carried regularly with clinical & radiological assessment till 8 weeks. All the patients were examined clinically & radiologically, including detail history of pre morbid status at the time of admission.
The data thus collected from patients was analyzed, evaluated, compared with each other & observations were recorded. Results evaluated clinically according to criteria of Crawford (Extension lag, flexion loss and pain) and radiologically and analyzed statistically by t-test.
Conclusion
According to this prospective study we concluded that surgical treatment by a single k-wire is better than conservative treatment as regard clinical and radiological results.
Conservative technique may have less complications, but the difference in
final clinical results is in favor of surgical treatment.