Clinical and Radiological Outcomes of Surgically Treated Pediatric Mallet Finger

Background: Pediatric mallet finger is characterized by the disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint and differs fundamentally from adult injuries because of the biomechanical and biological implications of an open physis. Despite these distinctions, the relationship between postoperative radiographic alignment and clinical extensor function in skeletally immature patients remains insufficiently defined. Objective: This study aimed to evaluate the clinical and radiological outcomes of pediatric patients who underwent surgical treatment for mallet finger; to determine the effectiveness of commonly used surgical techniques, extension-block pinning and retrograde Kirschner-wire (K-wire) fixation; and to investigate the association between radiographic angular correction and postoperative extensor function in skeletally immature patients. Materials and Methods: Twenty pediatric patients treated surgically between 2010 and 2024 were retrospectively reviewed. Patients were assessed for the duration of K-wire retention, postoperative follow-up period, DIP joint function according to the Crawford criteria, and radiographic angular measurements. Results: Twelve patients had Doyle type 4a fractures. The mean duration of K-wire retention was 39.85 days, and the mean postoperative follow-up was 42.1 ± 36.7 months. The mean preoperative distal phalanx–middle phalanx long-axis angle was 21.4° ±10.6°, which improved significantly to 10.4° ±7.9° postoperatively (P < 0.05). No residual extension lag was observed in any patient, and all outcomes were classified as “excellent” according to the Crawford criteria, within the scope of this categorical assessment. Conclusion: Surgical management of pediatric mallet finger using extension-block pinning combined with retrograde K-wire fixation yields favorable clinical and radiological outcomes. In selected pediatric patients who underwent surgical treatment, extension-block pinning combined with retrograde K-wire fixation was associated with favorable clinical and radiological outcomes. These results reflect the performance of this technique within defined surgical indications and should not be interpreted as superiority over conservative management.