Table 2.
Identified studies
| References | Design | Na (fract.) | Pb | Oc | Trauma | Fracture pattern | Type of treatment | Treatment details | LOE |
|---|---|---|---|---|---|---|---|---|---|
| Al-Qattan [23] | Pros. series | 15 (15) | P1 | 0% | Industrial | Long oblique Spiral |
Cerclage wires | Dorsal approach, longitudinally splitting extensor tendon, 2 or 3 pieces; light bandage overnight | IV |
| Al-Qattan [20] | Retro. cohort | 78 (78) | P1 | 26% | Industrial | Transverse (100%) | K-wires (transarticular) | Antegrade or retrograde insertion (fixed MCPJ, free PIPJ), 2 pieces; palmar splint 10 days, K-wire removal 4–5 weeks | IV |
| Interosseous loop wires | Dorsal approach/adjusting existing laceration, longitudinally splitting extensor tendon; light bandage overnight | ||||||||
| Al-Qattan [24] | Retro. series | 35 (35) | P1 | 100% | Industrial | Transverse (100%) | K-wires (extra-articular) | Antegrade insertion (N = 20), mid-lateral approach with retrograde insertion (N = 15), 1 or 2 pieces; no splint, K-wire removal 5–6 weeks | IV |
| Al-Qattan [21] | Pros. cohort | 20 (29) | P2 | 100% | Industrial | N.D. | K-wire | Insertion from tip of digit (fixed DIPJ, free PIPJ); K-wire removal 5 weeks | III |
| Başar [13] | Retro. cohort | 22 (22) | P1 | 0% | N.D. | Oblique (64%) Spiral (36%) |
Mini plate and screws | Dorsal approach, longitudinally splitting extensor tendon; splint 2 weeks | IV |
| Screws only | Dorsal approach, longitudinally splitting extensor tendon, ≥2 pieces; splint 3 weeks | ||||||||
| Brei-Thoma [25] | Retro. series | 25 (29) | P1 | 19% | N.D. | Basal transverse (50%) Transverse (28%) Oblique (17%) Spiral (6%) |
Plate and screws, plate | Dorsal approach/adjusting existing laceration, longitudinally splitting extensor tendon; removable splint 4 weeks | IV |
| Faruqui [22] | Retro. cohort | P1 | 0% | N.D. | Transverse Short oblique |
K-wires (transarticular) | Antegrade insertion (fixed MCPJ, free PIPJ), 2 pieces; splint 3–7 days, dorsal extension block splint 4 weeks, K-wire removal 3–4 weeks | IV | |
| K-wires (extra-articular) | Cross-pinning from radial and ulnar base, 2 pieces; splint 3–7 days, dorsal extension block splint 4 weeks, K-wire removal 3–4 weeks | ||||||||
| Franz [17] | Pros. series | 15 (20) | P1 | 0% | N.D. | Transverse (45%) Oblique (30%) Spiral (25%) |
LuCa | Metacarpal brace, dorsal extension PIPJs, free wrist, buddy tape | IV |
| Franz [16] | RCT | 65 (74) | P1 | 0% | N.D. | Basal transverse (53%) Transverse (13%) Oblique (17%) Spiral (12%) Longitudinal (4%) |
LuCa | Metacarpal brace, dorsal extension PIPJs, free wrist, buddy tape | II |
| Forearm cast | Dorsopalmar plaster splint, dorsal extension PIPJs, fixed wrist, buddy tape | ||||||||
| Held [18] | Pros. series | 23 (23) | P1 | 0% | Low velocityd | Transverse (39%) Oblique (39%) Complex (22%) |
Dorsal splint | Dorsal plaster slab, buddy tape | IV |
| Hornbach [14] | Retro. series | 11 (12) | P1 | 0% | N.D. | N.D. | K-wires (transarticular) | Antegrade insertion (fixed MCPJ, free PIPJ), 2 pieces; removable splint 3–4 weeks, K-wire removal 3–4 weeks | IV |
| Horton [19] | RCT | 28 (28) | P1 | N.D. | Sports, low velocityd | Long oblique Spiral |
K-wires (transversal) | Transversal insertion, 2 or 3 pieces; palmar slab 3–4 weeks, K-wire removal 4 weeks | II |
| Lag screws | Mid-lateral approach, excision lateral band extensor tendon, 2 pieces; splint 2 days, removable splint 3–4 weeks | ||||||||
| Nalbantoǧlu [15] | Retro. series | 17 (18) | P1, P2 | 0% | Low- velocityd | Transverse (6%) Oblique (39%) Spiral (22%) Comminuted (33%) |
Plate and screws and mini screws only | Dorsoulnar or radial approach w/o separating extensor tendon, ≥2 pieces; splint <3 weeks | IV |
| Patankar [26] | Pros. series | 35 (35) | P1 | 0% | Industrial, sports, low velocityd | Transverse (40%) Short oblique (34%) Long oblique (20%) Segmental (6%) |
Intra-medullary nailing | Dorsal approach, longitudinally splitting extensor tendon (N = 15), closed reduction (N = 20), 2 or 3 pieces; plaster slab 3 weeks | IV |
| Pehlivan [27] | Retro. series | 23 (23) | P1, P2 | 0% | N.D. | Transverse (100%) | Tension band wiring | Dorsal approach, longitudinally splitting extensor tendon | IV |
| Thomas [28] | Retro. series | 10 (10) | P1 | 100% | Road traffic accidents | Transverse (100%) | Theta fixation | Dorsal approach/adjusting existing laceration, longitudinally splitting extensor tendon; removable volar plaster 3 weeks | IV |
DIPJ distal interphalangeal joint, MCPJ metacarpophalangeal joint, N.D. not described, PIPJ proximal interphalangeal joint
aRemaining patients and fractures in analysis after excluding patients lost to follow-up or with incomplete data
bPhalanx: proximal (P1) or middle (P2)
cType I open fractures: without complete tendon injury or extensive soft tissue loss requiring reconstruction
dLow velocity: falling, straining, contusion