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The Ishiguro Technique for the Treatment of Adolescent Mallet Thumb Fracture

Gergo Jozsa*, Jeganeh Rafiei and Zsolt Oberritter

Introduction: Mallet thumb is the avulsion of the extensor pollicis longus tendon from the base of the distal phalanx with or without bony fragment. Abruption injuries of the extensor tendon are rare in adolescents and in most of the cases complete healing and functional restoration can be achieved by conservative treatment. However, when the disruption is extensive (i.e., it affects more than one third part of the articular surface) and the extent of the dislocation is more than 1.5 mm, then surgical intervention is necessary.

Aim: To present the feasibility of the Ishiguro’s method which is more beneficial than open surgery in the treatment of mallet thumb fracture.

Case report: A 16-year-old male patient presented tenderness and swelling around the interphalangeal joint of the right thumb. X-ray imaging showed fracture at the base of the distal phalanx including one third of the articular surface. Under digital nerve block anesthesia we performed closed reduction and extension block pinning. The right thumb was immobilized with Bennet splint for 3 weeks. The wires were removed 6 weeks after the primary intervention. Two month after the surgery, the patient acquired full extension and five degree flexion deficit in the interphalangeal joint. He was satisfied with function and cosmetics.

Summary: Ishiguro technique is an effective, safe, and easily applicable procedure for the treatment of mallet thumb fracture in the adolescent age group. In our reported case we were able to achieve good functional results without open surgery.