D . Vasu, e al. Ou come O Ex ension Block Pinning Fo Malle Finge . In . J Med. Pha m. Res., 6 (6): 398‐404, 2025
398
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
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O iginal A icle
Ou come O Ex ension Block Pinning Fo Malle Finge
D . Vasu1, D . Ni ish Sha ma2, D . Vishesh Am i 3, D . Pa iksha4, D . Sumedha Ghai5
1Pos g adua e Schola , Depa men o o hopaedics , Go e nmen Medical College S inaga , India
2Senio esiden , Depa men o o hopaedics , Go e nmen Medical College Ka hua, India
3Pos g adua e Schola , Depa men o o hopaedics , Go e nmen Medical College S inaga , India
4Pos g adua e Schola , Depa men o Gynaecology & Obs e ics , Go e nmen Medical College S inaga , India
5Pos g adua e Schola , Depa men o Oph halmology , Go e nmen Medical College S inaga , India
A B S T R A C T
Co esponding Au ho :
D . Vishesh Am i
Pos g adua e Schola , Depa men
o o hopaedics , Go e nmen
Medical College S inaga , India
Recei ed: 28-09-2025
Accep ed: 13-10-2025
A ailable online: 16-11-2025
Backg ound : Malle inge is a equen inju y o he e minal ex enso mechanism
o he dis al in e phalangeal (DIP) join , o en caused by an a ulsion ac u e o he
do sal base o he dis al phalanx. While conse a i e ea men using splin s emains
he s anda d o uncomplica ed so - issue malle s, su gical ixa ion becomes
necessa y in cases wi h ola subluxa ion o la ge a icula agmen in ol emen .
Ex ension-block pinning, in oduced by Ishigu o, has e ol ed in o a eliable,
minimally in asi e echnique ha ensu es accu a e join cong ui y and ea ly
ehabili a ion. Aim: The objec i e o his s udy was o e alua e he unc ional and
adiological ou comes o ex ension-block pinning in pa ien s wi h bony malle
inge ea ed by Depa men o O hopaedics a Go e nmen Medical College
S inaga . Me hods: A p ospec i e obse a ional s udy was conduc ed be ween
Janua y 2022 and June 2024 on 15 pa ien s (10 males, 5 emales) aged 18–55 yea s
(mean = 32.8 ± 9.6 yea s). Inclusion c i e ia we e acu e bony malle inge wi h
a icula su ace in ol emen g ea e han 30% o displacemen mo e han 2 mm,
and absence o p e ious inge de o mi y. Unde digi al block anes hesia and
luo oscopic guidance, a 1.0–1.2 mm K-wi e was in oduced pe cu aneously o
ex ension-block ixa ion, ollowed by a ans-DIP wi e o s abiliza ion. Pos -
ope a i e immobiliza ion was main ained o 6 weeks, ollowed by g adual
mobiliza ion and physio he apy. Clinical e alua ion was based on C aw o d’s
c i e ia, measu ing ex ension lag, lexion ange, and o al ac i e mo ion.
Radiological union, subluxa ion co ec ion, and complica ions we e assessed.
Resul s: All 15 pa ien s achie ed adiog aphic union a a mean o 6.4 ± 1.1 weeks.
Mean ollow-up was 12.5 mon hs ( ange 10–15 mon hs). Mean ex ension lag
imp o ed om 27.3° p e-ope a i ely o 4.6° a inal ollow-up, while mean DIP
lexion was 68.2° ± 8.1°. Mean o al ac i e mo ion was 72.8° ± 7.4°. Acco ding o
C aw o d’s c i e ia, esul s we e excellen in 9 pa ien s (60%), good in 4 (26.7%),
ai in 1 (6.7%), and poo in 1 (6.7%). Complica ions included wo cases (13.3%) o
supe icial pin- ac in ec ion managed conse a i ely and one case (6.7%) o
ansien nail de o mi y; no non-union o esidual subluxa ion was obse ed.
Conclusion: Ex ension-block pinning p o ides excellen unc ional and adiological
ou comes in selec ed cases o bony malle inge , wi h minimal complica ions and
high pa ien sa is ac ion. This echnique emains a eliable, cos -e ec i e op ion in
he managemen o displaced malle ac u es, pa icula ly in esou ce-limi ed
se ings such as e ia y hospi als in de eloping egions.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Malle inge , bony malle ac u e, ex ension-block pinning, Ki schne
wi e ixa ion, dis al in e phalangeal join , unc ional ou come.
INTRODUCTION
Inju y o he e minal ex enso mechanism o he dis al in e phalangeal (DIP) join , commonly e e ed o as malle
inge , ypically esul s om ei he a endon up u e o a bony a ulsion o he do sal base o he dis al phalanx. Fo ced
lexion o axial loading o he DIP join is a common mechanism in a hle es o du ing acciden al auma. [1] When a
D . Vasu, e al. Ou come O Ex ension Block Pinning Fo Malle Finge . In . J Med. Pha m. Res., 6 (6): 398‐404, 2025
399
bony agmen is in ol ed (bony malle ), managemen conside a ions change because o a icula su ace in ol emen .
Conse a i e ea men using ex ension splin ing may be adequa e o small a ulsion inju ies; howe e , when he
agmen in ol es mo e han one‐ hi d o he a icula su ace o when he e is ola subluxa ion o he dis al phalanx,
su gical ixa ion is o en ad oca ed o es o e join cong ui y and a oid la e sequelae such as a h osis, ex ension lag, o
swan-neck de o mi y. [2][3]
The su gical echnique o ex ension-block pinning, o iginally desc ibed by Ishigu o e al., uses a pe cu aneous Ki schne
wi e (K-wi e) inse ed do sally in o he middle phalanx (ex ension block) ollowed by s abiliza ion wi h a ans-DIP K-
wi e. This me hod is minimally in asi e, p ese es he ex enso mechanism, allows join educ ion unde luo oscopy,
and acili a es ea ly mobilisa ion. [4] Ea ly case se ies o his echnique epo ed high union a es and excellen unc ional
ou comes; o example, one e ospec i e se ies o 65 pa ien s ea ed wi h he ex ension-block me hod epo ed 46%
excellen , 32% good, 20% ai and 2% poo esul s acco ding o C aw o d’s c i e ia. [5]
Despi e a ou able epo s, some issues emain un esol ed. Fi s , he op imal indica ions such as agmen size h eshold,
deg ee o subluxa ion, and ime om inju y o su ge y a e a iably de ined ac oss s udies. [6] Second, p edic o s o sub-
op imal ou come a e ex ension-block pinning ha e been no ed: olde age, delayed su ge y, esidual a icula s ep-o ,
and subop imal wi e inse ion angle ha e been associa ed wi h poo e esul s. [7] These obse a ions unde sco e ha
while ex ension-block pinning is widely adop ed, pa ien selec ion and su gical echnique play key oles in ou comes.
In ou e ia y hospi al se ing a Go e nmen Medical College S inaga , we ound a lack o egion‐speci ic da a on
ex ension-block pinning o malle inge —including du ing pe iods o esou ce cons ain and a ied ollow-up
compliance. The e o e, we conduc ed a p ospec i e obse a ional s udy o 15 pa ien s ea ed o e an 18-mon h pe iod
(2022–2024) o e alua e he unc ional and adiological ou comes o ex ension-block pinning o displaced bony malle
inju ies in ou popula ion.
MATERIALS AND METHODS
S udy Design and Se ing
This p ospec i e obse a ional s udy was conduc ed in he Depa men o O hopaedics, Go e nmen Medical College,
S inaga , be ween Janua y 2022 and June 2024. The s udy aimed o assess he unc ional and adiological ou comes o
ex ension-block pinning in he managemen o displaced bony malle inge inju ies. E hical app o al o he s udy was
ob ained om he Ins i u ional E hics Commi ee p io o commencemen , and in o med consen was aken om all
pa icipan s.
S udy Popula ion
A o al o 15 consecu i e pa ien s p esen ing wi h bony malle inge we e included in he s udy. The inclusion c i e ia
we e:
1. Age be ween 18 and 55 yea s.
2. Acu e bony malle inge inju y (wi hin 2 weeks o auma).
3. Radiological e idence o a do sal a ulsion ac u e in ol ing mo e han one- hi d o he a icula su ace o
displacemen g ea e han 2 mm.
4. Cases wi h ola subluxa ion o he dis al phalanx con i med on la e al X- ay iew.
The exclusion c i e ia we e:
1. Old neglec ed malle inge inju ies (mo e han 3 weeks pos -inju y).
2. Open ac u es o associa ed endon lace a ions.
3. Comminu ed ac u es unsui able o pe cu aneous ixa ion.
4. Pa ien s wi h p io su ge y o p e-exis ing de o mi y o he in ol ed inge .
5. Pa ien s unwilling o pa icipa e o unable o comply wi h ollow-up.
P eope a i e E alua ion
Each pa ien unde wen ho ough clinical e alua ion including his o y, mechanism o inju y, and physical examina ion o
he a ec ed digi o ende ness, swelling, and ex enso lag a he dis al in e phalangeal (DIP) join . S anda d
an e opos e io and la e al adiog aphs we e ob ained o assess agmen size, displacemen , and he p esence o ola
subluxa ion. Rou ine p eope a i e in es iga ions we e ca ied ou as pe ins i u ional p o ocol.
Su gical Technique
All p ocedu es we e pe o med unde digi al block anes hesia and s ic asep ic p ecau ions in he mino ope a ing
hea e. The pa ien was placed supine wi h he hand es ing on a adiolucen hand able. Unde luo oscopic guidance,
he DIP join was lexed o expose he do sal a icula agmen .
A 1.0–1.2 mm Ki schne wi e (K-wi e) was inse ed pe cu aneously in o he do sal aspec o he head o he middle
phalanx a app oxima ely a 45° angle o he long axis o he inge . The wi e was ad anced un il i made i m con ac
wi h he ac u e agmen , ac ing as an “ex ension block.” The dis al phalanx was hen gen ly ex ended o achie e
D . Vasu, e al. Ou come O Ex ension Block Pinning Fo Malle Finge . In . J Med. Pha m. Res., 6 (6): 398‐404, 2025
400
educ ion o he do sal a ulsion agmen , and a second 1.0 mm K-wi e was passed ansa icula ly ac oss he DIP join
o main ain he educ ion. P ope educ ion and wi e placemen we e con i med in bo h an e opos e io and la e al
luo oscopic iews.
A e sa is ac o y ixa ion, he wi es we e ben and cu sho ou side he skin. A s e ile d essing was applied, and a do sal
aluminum splin was used o immobilize he DIP join in sligh ex ension while allowing mo emen a he p oximal
in e phalangeal (PIP) join .
Pos ope a i e Ca e and Rehabili a ion
All pa ien s we e discha ged on he same day wi h o al an ibio ics and analgesics o i e days. D essing changes we e
done e e y 3–4 days, and pin ac inspec ion was ca ied ou a each isi . Pa ien s we e ad ised o keep he inge
ele a ed and o pe o m ange o mo ion exe cises o he una ec ed join s.
The ansa icula K-wi e was emo ed a e 6 weeks unde local anes hesia once adiog aphic signs o union we e
obse ed. Gen le ac i e lexion and ex ension exe cises o he DIP join we e ini ia ed a ha ime. Full un es ic ed hand
use was pe mi ed a e 8–10 weeks.
Follow-Up and E alua ion
Pa ien s we e ollowed up a 2 weeks, 6 weeks, 3 mon hs, 6 mon hs, and 12 mon hs pos ope a i ely. A each isi , clinical
assessmen and adiog aphs we e pe o med. Func ional e alua ion was based on C aw o d’s c i e ia, which assessed he
inal ange o mo ion and p esence o pain o de o mi y. The c i e ia we e as ollows:
* Excellen : Full ange o mo ion and no pain.
* Good: Ex ension lag less han 10° and no pain.
* Fai : Ex ension lag 10–25° wi h o wi hou pain.
* Poo : Ex ension lag mo e han 25° o pe sis en pain.
Radiological e alua ion included assessmen o bone union, alignmen , and a icula cong ui y. Union was de ined as he
absence o isible ac u e line wi h con inuous abecula pa e n ac oss he ac u e si e.
S a is ical Analysis
All collec ed da a we e abula ed and analyzed using Mic oso Excel and SPSS e sion 26.0 so wa e. Desc ip i e
s a is ics such as mean, s anda d de ia ion, and ange we e used o summa ize quan i a i e a iables. Ca ego ical da a
we e exp essed in equencies and pe cen ages.
Func ional ou comes (C aw o d’s g ades) we e compa ed wi h a iables such as age, delay in p esen a ion, and ac u e
pa e n. The ela ionship be ween con inuous a iables (ex ension lag, lexion ange, o al ac i e mo ion) and ou come
ca ego ies was assessed using he S uden ’s - es . A p- alue o less han 0.05 was conside ed s a is ically signi ican .
RESULTS
The p esen s udy included 15 pa ien s wi h displaced bony malle inge who unde wen ex ension-block pinning a
Go e nmen Medical College S inaga be ween Janua y 2022 and June 2024. All pa ien s comple ed a minimum ollow-
up pe iod o 12 mon hs. The ou comes we e analyzed clinically and adiologically acco ding o C aw o d’s c i e ia and
adiog aphic pa ame e s o ac u e union and alignmen .
The s udy g oup consis ed o 10 males (66.7%) and 5 emales (33.3%), wi h an age ange be ween 18 and 55 yea s and a
mean age o 32.8 ± 9.6 yea s. The dominan hand was in ol ed in 9 cases (60%), while he non-dominan hand was
a ec ed in 6 cases (40%). The middle inge was mos equen ly in ol ed (40%), ollowed by he ing inge (26.7%),
index inge (20%), and li le inge (13.3%). The mos common mode o inju y was spo s- ela ed auma, obse ed in 8
pa ien s (53.3%), ollowed by acciden al alls in 5 pa ien s (33.3%) and occupa ional inju ies in 2 pa ien s (13.3%) [Table
1].
Table 1: Demog aphic and Inju y Cha ac e is ics o Pa ien s (n = 15)
Pa ame e
Ca ego y
No. O Pa ien s (n=15)
Pe cen age (%)
Age (yea s)
18–25
4
26.7
26–40
7
46.7
41–55
4
26.7
Mean age ± SD
--
32.8 ± 9.6
--
Gende
Male
10
66.7
Female
5
33.3
Side o in ol emen
Righ
9
60
Le
6
40
A ec ed inge
Index
3
20
Middle
6
40
D . Vasu, e al. Ou come O Ex ension Block Pinning Fo Malle Finge . In . J Med. Pha m. Res., 6 (6): 398‐404, 2025
401
Ring
4
26.7
Li le
2
13.3
Mechanism o inju y
Spo s inju y
8
53.3
Fall
5
33.3
Occupa ional
2
13.3
All pa ien s had a do sal a ulsion ac u e in ol ing mo e han one- hi d o he a icula su ace. The mean agmen
displacemen was 2.6 ± 0.5 mm. Vola subluxa ion o he dis al phalanx was seen in 5 pa ien s (33.3%). No open
ac u es o comminu ed agmen s we e included in he se ies [Table 2].
Table 2: P eope a i e Radiog aphic Findings
Radiog aphic Pa ame e
Mean ± SD / n
Pe cen age (%)
F agmen size (% o a icula su ace)
36.8 ± 5.4
--
F agmen displacemen (mm)
2.6 ± 0.5
--
Vola subluxa ion
5
33.3
Closed ac u es
15
100
Comminu ion
0
0
All ac u es achie ed adiological union a a mean du a ion o 6.4 ± 1.1 weeks. The mean p eope a i e ex ension lag
was 27.3°, which imp o ed o 4.6° a he inal ollow-up. The mean lexion a he DIP join was 68.2° ± 8.1°, and he
mean o al ac i e mo ion was 72.8° ± 7.4° [Table 3].
Table 3: Pos ope a i e and Func ional Ou comes
Pa ame e
Mean ± SD
Range
Time o adiological union (weeks)
6.4 ± 1.1
5–8
P eope a i e ex ension lag (°)
27.3 ± 5.2
18–38
Pos ope a i e ex ension lag (°)
4.6 ± 2.8
0–9
Final DIP join lexion (°)
68.2 ± 8.1
55–80
To al ac i e mo ion (°)
72.8 ± 7.4
60–85
Acco ding o C aw o d’s c i e ia, excellen ou comes we e achie ed in 9 pa ien s (60%), good in 4 pa ien s (26.7%), ai
in 1 pa ien (6.7%), and poo in 1 pa ien (6.7%) [Table 4].
Table 4: Ou come E alua ion Based on C aw o d’s C i e ia
C aw o d’s G ade
C i e ia
No. O Pa ien s
Pe cen age (%)
Excellen
Full mo ion, no pain
9
60
Good
Ex ension lag <10°, no pain
4
26.7
Fai
Ex ension lag 10°–25°
1
6.7
Poo
Ex ension lag >25° o pe sis en pain
1
6.7
Mino complica ions occu ed in 3 pa ien s (20%), all o which we e managed conse a i ely. Two pa ien s de eloped
supe icial pin ac in ec ions ha esol ed wi h local ca e and o al an ibio ics. One pa ien had ansien nail de o mi y
ha imp o ed spon aneously. No cases o non-union, deep in ec ion, o esidual subluxa ion we e no ed [Table 5].
Table 5: Complica ions Obse ed
Complica ion
No. O Pa ien s
Pe cen age (%)
Managemen
Ou come
Supe icial pin ac
in ec ion
2
13.3
Local ca e, o al
an ibio ics
Healed
Nail de o mi y
( ansien )
1
6.7
Obse a ion
Resol ed
Non-union
0
0
--
--
Deep in ec ion
0
0
--
--
Residual subluxa ion
0
0
--
--
D . Vasu, e al. Ou come O Ex ension Block Pinning Fo Malle Finge . In . J Med. Pha m. Res., 6 (6): 398‐404, 2025
402
Ba g aph: Imp o emen in Ex ension Lag.
Ba g aph 2: Func ional Ou comes Based on C aw o d’s C i e ia.
DISCUSSION
In his p ospec i e se ies o 15 pa ien s ea ed wi h he ex ension-block pinning echnique a Go e nmen Medical
College, S inaga , o e an 18-mon h pe iod, we obse ed a o able adiological union and unc ional ou comes wi h a
low complica ion a e. All ac u es uni ed a a mean o 6.4 weeks, mean ex ension lag imp o ed o 4.6°, and 86.7% o
pa ien s achie ed “excellen ” o “good” esul s as pe C aw o d G.P. c i e ia. These indings a e consis en wi h p e ious
epo s suppo ing he e icacy o ex ension-block pinning in displaced bony malle inju ies [8][9].
The ana omical educ ion and s abili y p o ided by he echnique a e he main ac o s con ibu ing o consis en ly good
ou comes. Han e al. Compa ed he ex ension-block pinning me hod wi h di ec pinning and ound bo h echniques
p oduced accep able esul s, wi h he ex ension-block echnique achie ing be e cosme ic and unc ional sco es in many
cases [10]. Ou se ies demons a ed a mean dis al in e phalangeal (DIP) join lexion o 68.2° and o al ac i e mo ion o
72.8°, which aligns wi h o he s udies whe e DIP lexion a e aged a ound 62–65° ollowing pe cu aneous ex ension-
block ixa ion [11][12]. Ea ly in e en ion and uni o m su gical echnique likely con ibu ed o ou imp o ed mo ion
ange and minimal ex enso lag.
Pa ien selec ion plays a c ucial ole in de e mining inal ou comes. S udies ha e highligh ed ha agmen size, delay in
su ge y, esidual join s ep-o , ixa ion angle, and p esence o ola subluxa ion a e signi ican p ognos ic ac o s
[12][13]. Yildi im e al. Obse ed ha delayed p esen a ion, ad anced age, and esidual a icula incong ui y nega i ely
a ec ed pos ope a i e mo ion and unc ional ou come [12]. Ou s udy excluded ch onic o comminu ed inju ies and
ope a ed only on acu e cases (wi hin wo weeks o inju y), which p obably explains ou highe a e o excellen and good
esul s.
Complica ions ollowing ex ension-block pinning a e ela i ely uncommon bu include pin- ac in ec ion, nail de o mi y,
and s i ness. In ou s udy, he complica ion a e was 20%— wo supe icial pin- ac in ec ions (13.3%) and one ansien
nail de o mi y (6.7%). These esul s a e compa able wi h hose epo ed in la ge case se ies, such as he s udy by
Dieckmann e al., whe e 84.2% o cases had no complica ions and 15.8% had mino issues like supe icial in ec ion o
nail changes [11]. S ic asep ic echnique, ea ly pin emo al, and p ope pos ope a i e ca e emain essen ial o minimize
complica ions [14].
The ex ension-block echnique is especially ad an ageous in esou ce-limi ed se ups due o i s simplici y, ep oducibili y,
and minimal in asi eness. Compa ed wi h open educ ion and sc ew ixa ion, i a oids so issue dis up ion and educes
D . Vasu, e al. Ou come O Ex ension Block Pinning Fo Malle Finge . In . J Med. Pha m. Res., 6 (6): 398‐404, 2025
403
ope a i e ime. A andomized ial compa ing splin ing wi h ex ension-block pinning o bony malle inge ac u es
ound simila unc ional ou comes, bu su gical ixa ion allowed ea lie mobiliza ion and lowe a es o seconda y
subluxa ion [15]. The e o e, in ca e ully selec ed acu e cases, ex ension-block pinning ep esen s a p agma ic and
e ec i e ea men s a egy.
Ne e heless, his s udy has limi a ions. The small sample size (n=15) and single-cen e design limi gene alizabili y. The
mean ollow-up o 12.5 mon hs may no ully cap u e la e degene a i e changes, such as pos - auma ic a h i is o swan-
neck de o mi y. Fu he mo e, he absence o a non-ope a i e o al e na i e ope a i e con ol g oup es ic s de ini i e
compa a i e analysis. These ac o s sugges he need o la ge , mul icen e , andomized s udies compa ing a ious
ixa ion echniques and long- e m ou comes [16][17].
CONCLUSION
In conclusion, ou s udy ein o ces ha ex ension-block pinning is a sa e, eliable, and e ec i e su gical echnique o
ea ing displaced bony malle inge ac u es. I achie es high union a es, good unc ional eco e y, and minimal
complica ions when applied o p ope ly selec ed acu e cases. Me iculous su gical echnique and a en i e pos ope a i e
ca e a e pa amoun o ensu e op imal esul s.
Con lic o in e es : Nil
Funding: Nil
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