{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:20:55Z","timestamp":1760145655562,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T00:00:00Z","timestamp":1724457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>After failed conservative therapy or in the absence of any intervention, a rupture of the digital subcutaneous extensor tendon at the distal interphalangeal (DIP) joint, known as mallet finger, may lead to a chronic extension deficit due to excessive scarring and tendon elongation. Various surgical techniques to restore the extension of the distal phalanx have been proposed, but an optimal approach has not yet been established. To tighten the extensor tendon, a purse-string suture can be applied. Although it has shown efficacy, it can result in significant bulging and scar formation. Using the \u201cabbreviato\u201d technique, the elongated part of the extensor tendon is excised, and the tendon is re-sutured. Also, tenodesis has been described, particularly in pediatric cases. In this retrospective follow-up study, we aimed to investigate if the step-plasty procedure previously described by Baumeister provides comparable, if not superior, functional and aesthetic outcomes compared to existing techniques for patients with chronic mallet finger. In this retrospective study, a consecutive series of 68 patients with chronic mallet fingers was enrolled. Patients were treated surgically using step-plasty of the respective extensor tendon. After skin incision and tenolysis, the elongated extensor tendon was incised in a Z-like fashion and stepwise resected in the transverse portion of the Z. The functional and aesthetic effects of this step-plasty technique were compared with results of 44 patients previously treated using purse-string sutures of the extensor tendon and evaluated using Crawford\u2019s and Levante\u2019s criteria. In all patients undergoing the step-plasty procedure, the extension deficit was significantly reduced from an average of 42 degrees preoperatively to 11 degrees postoperatively. In contrast, the control group treated by purse-string sutures showed a slightly higher postoperative extension deficit of 15 degrees. According to Levante\u2019s criteria, the results of our step-plasty procedure were significantly better than those achieved with purse-string sutures. Our study demonstrated that the treatment of older or chronic subcutaneous extensor tendon ruptures using the step-plasty technique led to a significant reduction in extension deficits. According to Levante\u2019s criteria, the postoperative outcome was significantly better in comparison to the purse-string suture technique. Additionally, no skin resection was required to improve the extension capability of the distal finger joint, compared to established surgical procedures.<\/jats:p>","DOI":"10.3390\/jfmk9030144","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T01:48:49Z","timestamp":1724636929000},"page":"144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reconstruction of Chronic Soft Tissue Mallet Fingers: Outcomes of Step-Plasty vs. Purse-String Suture"],"prefix":"10.3390","volume":"9","author":[{"given":"Wolfram","family":"Demmer","sequence":"first","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstra\u00dfe 5, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Frick","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstra\u00dfe 5, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u00fcdiger G. H.","family":"Baumeister","sequence":"additional","affiliation":[{"name":"Lymphology Unit, Urologische Klinik Muenchen Planegg, 82152 Planegg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-4122","authenticated-orcid":false,"given":"Elisabeth","family":"Haas-L\u00fctzenberger","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstra\u00dfe 5, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1103-3775","authenticated-orcid":false,"given":"Nikolaus","family":"Thierfelder","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstra\u00dfe 5, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinan","family":"Mert","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstra\u00dfe 5, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9394-8412","authenticated-orcid":false,"given":"Denis","family":"Ehrl","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital Paracelsus Medical University, 90419 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Giunta","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, Ziemssenstra\u00dfe 5, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane G.","family":"St\u00e4uble","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Anaesthesiologie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"336","DOI":"10.5435\/00124635-200509000-00007","article-title":"Mallet finger","volume":"13","author":"Bendre","year":"2005","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/TME.0000000000000251","article-title":"Mallet Finger","volume":"41","author":"Ramponi","year":"2019","journal-title":"Adv. Emerg. Nurs. J."},{"key":"ref_3","unstructured":"Green, D.P. (1999). Extensor Tendons: Acute Injuries, Churchill Livingstone. [4th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"658","DOI":"10.2106\/00004623-198466050-00003","article-title":"Mallet fractures","volume":"66","author":"Wehbe","year":"1984","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s11552-014-9609-y","article-title":"Current concepts: Mallet finger","volume":"9","author":"Alla","year":"2014","journal-title":"Hand"},{"key":"ref_6","unstructured":"Khera, B., Chang, C., and Bhat, W. (2021). An overview of mallet finger injuries. Acta Biomed., 92."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/0363-5023(94)90200-3","article-title":"Mallet finger: Results of early versus delayed closed treatment","volume":"19","author":"Garberman","year":"1994","journal-title":"J. Hand Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.jhsa.2005.02.010","article-title":"Nonsurgical treatment of closed mallet finger fractures","volume":"30","author":"Kalainov","year":"2005","journal-title":"J. Hand Surg. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/S0363-5023(86)80202-7","article-title":"Conservative management of chronic mallet finger","volume":"11","author":"Patel","year":"1986","journal-title":"J. Hand Surg. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jht.2015.03.001","article-title":"Conservative treatment of mallet finger: A systematic review","volume":"28","author":"Valdes","year":"2015","journal-title":"J. Hand Ther."},{"key":"ref_11","unstructured":"Meals, R.A. (2024, August 19). Mallet Finger Treatment & Management. Available online: https:\/\/emedicine.medscape.com\/article\/1242305-treatment?form=fpf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1177\/1558944716642763","article-title":"The Diagnosis and Management of Mallet Finger Injuries","volume":"12","author":"Lamaris","year":"2017","journal-title":"Hand"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/00006534-199401000-00022","article-title":"Reassessment of surgery for mallet finger","volume":"93","author":"Nakamura","year":"1994","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/BF02449751","article-title":"Zur Behandlung des geschlossenen Strecksehnenabrisses am Fingerendglied","volume":"292","author":"Georg","year":"1959","journal-title":"Langenbecks Arch. Klin. Chir."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/0266-7681_89_90102-2","article-title":"Abbrevatio: A new operation for chronic mallet finger","volume":"14","author":"Lind","year":"1989","journal-title":"J. Hand Surg. Br."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/S0363-5023(77)80095-6","article-title":"A simplified technique for treating mallet fingers: Tenodermodesis","volume":"2","author":"Iselin","year":"1977","journal-title":"J. Hand Surg. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/BTH.0b013e31812f5714","article-title":"Tenodermodesis for chronic mallet finger deformities in children","volume":"11","author":"Shin","year":"2007","journal-title":"Tech. Hand Up. Extrem. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/S0363-5023(78)80144-0","article-title":"The spiral oblique retinacular ligament (SORL)","volume":"3","author":"Thompson","year":"1978","journal-title":"J. Hand Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00003086-199311000-00024","article-title":"Use of a Herbert screw for interphalangeal joint arthrodesis","volume":"296","author":"Katzman","year":"1993","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/S0363-5023(83)80275-5","article-title":"Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand)","volume":"8","author":"Kleinert","year":"1983","journal-title":"J. Hand Surg. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/S0363-5023(96)80106-7","article-title":"Effect of peripheral suture depth on strength of tendon repairs","volume":"21","author":"Diao","year":"1996","journal-title":"J. Hand Surg. Am."},{"key":"ref_22","unstructured":"Ryan, J.D. (2024, August 01). Principles and Techniques of Tendon and Ligament Repair, Available online: www.podiatryinstitute.com\/pdfs\/Update_2010\/2010_52.pdf."},{"key":"ref_23","first-page":"292","article-title":"Step-plasty for therapy of chronic subcutaneous ruptures of extensor tendons of finger end joints","volume":"24","author":"Baumeister","year":"1992","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_24","unstructured":"Debrunner, H.U. (1971). Gelenkmessung (Neutral-0-Methode), L\u00e4ngenmessung, Umfangmessung, Bulletin des Offiziellen Organs der Arbeitsgemein-schaft f\u00fcr Osteosynthesefragen."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1093\/ptj\/67.12.1867","article-title":"Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity","volume":"67","author":"Gajdosik","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0363-5023(84)80148-3","article-title":"The molded polythene splint for mallet finger deformities","volume":"9","author":"Crawford","year":"1984","journal-title":"J. Hand Surg. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S1297-3203(02)00008-2","article-title":"Surgical treatment of chronic mallet finger by shortening\u2013suture of the tendon scar. Sixty six cases","volume":"22","author":"Levante","year":"2003","journal-title":"Chir. Main"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/0266-7681_86_90019-7","article-title":"The excursions of the long extensor tendons of the hand","volume":"11","author":"Elliot","year":"1986","journal-title":"J. Hand Surg. Br."},{"key":"ref_29","unstructured":"Burton, R.I. (1988). Extensor Tendons: Late Reconstruction, Churchill Livingstone. [5th ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1097\/01.prs.0000232983.23840.f2","article-title":"Pull-in suture technique for the treatment of mallet finger","volume":"118","author":"Ulusoy","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/0363-5023(90)90102-W","article-title":"Functional range of motion of the joints of the hand","volume":"15","author":"Hume","year":"1990","journal-title":"J. Hand Surg. Am."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"382","DOI":"10.3122\/15572625-11-5-382","article-title":"Conservative versus surgical treatment of mallet finger: A pooled quantitative literature evaluation","volume":"11","author":"Geyman","year":"1998","journal-title":"J. Am. Board. Fam. Pract."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/9\/3\/144\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:42:41Z","timestamp":1760110961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/9\/3\/144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,24]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["jfmk9030144"],"URL":"https:\/\/doi.org\/10.3390\/jfmk9030144","relation":{},"ISSN":["2411-5142"],"issn-type":[{"type":"electronic","value":"2411-5142"}],"subject":[],"published":{"date-parts":[[2024,8,24]]}}}