Denis Gerlac
Introduction: During the period of immobilization of mallet-fractures treated in an orthopedic way, there is sometimes a harmful secondary displacement of the distal fragment. Method: At present the splints mostly used to stabilize and immobilize the seats of these fractures, depending on opinions, are either homemade dorsal tiles or Stack splints. We have chosen to use the "custom-made" Stack’s splint. Result: The final assessment has been carried out after six months. We found no secondary displacement. The recovered mobility is excellent. The results are excellent according to the standardized criteria. Discussion: In this presentation we explain why we preferred to use, for these two mallet-fractures, a "custommade" Stack’s splint rather than a dorsal tile. The main advantage of the "custom-made" Stack is the presence of a counter surface under the Distal-Inter- Phalanx (DIP). It decreases the risk of the distal fragment of the ungueal phalanx sliding down especially if we perform, to reduce the fracture, an upward push under the distal extremity of the distal fragment. This counter surface seems to us important to counteract, throughout the treatment, against volar sliding. Conclusion: Both splints have the same function: to stabilize the extremity of the finger. Their modes of action are very similar they use holds and counter-holds to immobilize the extremity of the finger. On the other hand the "custom-made" Stack’s splint has the advantage that the dorsal tile does not have: a counter-hold placed under the seat of the fracture. For this reason we recommend using a "custom-made" Stack’s splint in spite of its drawbacks (maceration and occlusion of the pulp).
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