Conservative Treatment of an Acute Closed Mallet Thumb-A Case Report and Literature Review

保守治療急性閉合性槌狀大拇指－病例報告及文獻回顧

劉品含(Pin-Han Liu) ； 謝式洲(Shyh-Jou Shieh)

《臺灣整形外科醫學會雜誌》 31卷1期 (2022/03) Pp. 55-63

摘要

Background: A mallet thumb is a rare deformity attributed to the anatomic differences between extensor pollicis longus and extensor tendons of fingers. Experience in treating this is limited and treatment methods remain controversial. Since the thumb is the most functional digit of the hand, it is necessary to restore its function in the best way possible. We report a case and review the literature regarding the treatment of a closed mallet thumb. Aim and Objectives: We present a case with closed mallet thumb and share our experience regarding conservative splinting. Related literatures were reviewed and discussed to conclude the consensus regarding the treatment of acute closed mallet thumb. Materials and Methods: A 65-year-old male presented with mallet deformity of the left thumb without an open wound. A closed mallet thumb was diagnosed with interphalangeal joint (IP) with a 40° extension lag on X-ray. We used conservative treatment with customized gutter splint for 4 weeks followed by 2 weeks of night splint. Related articles were reviewed and we made comparison between previous experiences and our case. Results: The outcome was quite good with full range of motion of left thumb IP joint. Neither re-ruptured nor stiffness was noted at 10-week follow-up. Conclusion: By using the customized gutter splint, acute closed mallet thumb can be simply treated conservatively for 4 weeks followed by night splint for 2 weeks.

關鍵字

mallet thumb ； conservative treatment

並列摘要

背景：由於大拇指伸拇長肌肌腱與其他手指伸肌鍵解剖結構上的不同，槌狀大拇指較不易發生而少見，在相關的治療經驗較少的情況下，對此疾病的治療方式的歧見也就一直存在著。然而，因為大拇指是手部功能最重要的一指，我們應該盡己所能幫病患恢復大拇指的功能。本篇報告一個急性閉合性槌狀大拇指的案例並做文獻回顧。目的及目標：藉由一個急性閉合性槌狀大拇指的案例，分享我們使用保守治療的經驗，並回顧相關文獻。材料及方法：一位六十五歲男性被診斷左手閉合性槌狀大拇指並有四十度無法伸展的現象，我們使用客製化副木固定作為保守治療，持續四周再加上兩周的夜間副木固定。我們搜尋了相關文獻並與本案例的治療方式做比較。結果：病人在治療後的預後良好，不僅大拇指的指間關節能做出全幅度活動，在十周後的追蹤下，也沒有肌腱再度斷裂或是關節僵硬的狀況。結論：對於急性閉合性槌狀大拇指，我們建議可以使用四周的客製化副木固定，再加上兩周夜間副木固定的非開刀的保守性治療。