The lesions of the distal extensor aponeurosis (Mallet finger) due to various types of injuries represent an intruding and disabling affection of the fingers, which can lead, despite treatment, to joints modifications and movements’ impairments. Various methods of repair were recommended from splint immobilization for long period to tendon reconstruction by different techniques. Material and method

We improved our previous technique based on a long, thin (2-3mm) deepithelised skin bandelet harvested from one border of the longitudinal incision made to explore the lesion taking also two transversal bandelets at the IPD joint. We have thus also a dermotenodese effect combined with a longitudinal and transversal consolidation of the extensor mechanism. The bandelet is reinserted distally at the base of the distal phalanx through a transosseous wire and also sutured to the remained aponeurosis.

The bandelet is the buried subcutaneous by skin closure over it. The finger is then immobilized on a splint for three weeks after that we start the controlled mobilization. In certain cases we use a centromedulary K – wire immobilization of the DIP for the same period.

Results

We used this method in 83 cases, with mallet finger recidives in only 8 cases from which 3 required arthrodesis. The patients regain 75 to 90% of DIP mobility with a loss of extension from 5 to 10 degrees.

Conclusions.

Simple and effective, this method avoids a prolonged and uncertain immobilization and has a significantly high percent of success.

The method uses local resources and avoids the rejection phenomenon related to allograft materials. The lateral bandelets improve the strength and stability of the tenodermodese.

The distal transosseous reinsertion and centromedulary splint are important technical adjuvant and improve the final result.