골성 추지의 신전 제한 핀 고정 수기에서의 골절편 정복 가능성에 대한 평가 = Evaluation of Fragment Reduction Feasibility When Treating Bony Mallet Finger Using Extension Block K-Wire Technique

다국어 초록 (Multilingual Abstract)

Purpose: The purpose was to evaluate fragment reduction feasilibty when applying extension block Kirschner-wire technique for bony mallet finger.
Methods: We treated 48 displaced mallet finger fractures by a two extension block Kirschner-wire technique. Among these operation group, we found dorsal rotation of fragment in 18 cases, making it difficult to get anatomical reduction.
The patients were divided into two groups. One group of 30 patients did not show dorsal rotation of fragment and anatomical reduction was achieved easily. Another group of 18 patients showed dorsal rotation of fragment and additional methods was applied to achieve anatomical reduction.
Results: Joint surface involvement was significant greater in groups showing dorsal rotation of fragment than group which did not show (57.1% and 49.7%, respectively) (p=0.01). The groups whose joint surface involvement more than 50% had higher risk of dorsal rotation of fragment than the group less than 50%, with the odds ratio of 6.11.
Conclusion: We could encounter the cases which showed dorsal rotation of the fracture fragment when treating the bony mallet finger with extension block K-wire technique especially the joint surface involvement was more than 50%. So if we can evaluate the extents of joint surface involvement and prepare additional method preoperatively when dorsal rotation of fragment is expected, it is possible to get more favorable results.

국문 초록 (Abstract)

목적: 골성 추지에서 K-강선을 이용한 신전 제한법 술식을 시행할 때 골절편의 정복 가능성에 영향을 주는 인자들을 분석하여, 어떤 경우에 정복이 잘 되지 않는지 알아보고자 한다.
방법: 48명의 골성 망치 수지 골절 환자를 2개의 K-강선을 신전 제한법으로 삽입하는 술식으로 수술을 시행하였으며, 이 중 18예에서 수술 중 골절편의 배측 회전으로 정복이 어려워 추가적인 술식을 시행하였다. 이에 어떠한 경우에 골절편의 배측 회전이 잘 일어나는지 특성을 분석하였다.
결과: 골절편의 배측 회전 현상을 보인 군과 보이지 않은 군 사이에 다른 변수들에서는 유의한 차이가 없었으나, 관절면의 침범 정도는 배측 회전 현상을 보인 군에서 유의하게 더 컸다(49.7% vs. 57.1%, p=0.01). 또한 관절면 침범이 50% 이상인 경우 골절편의 배측 회전을 보일 위험도는 6.11이었으며 유의하였다(p=0.02).
결론: 관절면의 침범이 50% 이상인 경우 신전제한 술식을 적용할 때 골절편의 배측 회전 현상으로 인해 정복에 어려움을 겪을 수 있다. 수술 전에 이러한 특성을 미리 파악하여 정복이 여의치 않을 경우를 대비하여 기존에 보고된 다양한술식을 같이 준비하여 수술은 준비한다면 좋은 결과를 얻을 수 있을 것으로 기대한다.

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