Mallet Finger (Baseball Finger) – OrthoInfo

Mallet finger injuries that are not treated typically result in stiffness and deformity of the injured fingertip. The majority of mallet finger injuries can be treated without surgery.

In children, mallet finger injuries may involve the cartilage that controls bone growth. The doctor must carefully evaluate and treat this injury in children, so that the finger does not become stunted or deformed.

Nonsurgical Treatment

Most mallet finger injuries are treated with splinting. A splint holds the fingertip straight (in extension) until it heals.

To restore function to the finger, the splint must be worn full time for 8 weeks. This means that it must be worn while bathing, then carefully changed after bathing. As the splint dries, you must keep your injured finger straight. If the fingertip droops at all, healing is disrupted and you will need to wear the splint for a longer period of time.

Because wearing a splint for a long period of time can irritate the skin, your doctor may talk with you about how to carefully check your skin for problems. Your doctor may also schedule additional visits over the course of the 8 weeks to monitor your progress.

For 3 to 4 weeks after the initial splinting period, you will gradually wear the splint less frequently — perhaps only at night. Splinting treatment usually results in both acceptable function and appearance, however, many patients may not regain full fingertip extension.

For some patients, the splinting regimen is very difficult. In these cases, the doctor may decide to insert a temporary pin across the fingertip joint to hold it straight for 8 weeks.

Surgical Treatment

Your doctor may consider surgical repair if there is a large fracture fragment or the joint is out of line (subluxed). In these cases, surgery is done to repair the fracture using pins to hold the pieces of bone together while the injury heals.

It is not common to treat a mallet finger surgically if bone fragments or fractures are not present. Surgical treatment of the damaged tendon usually requires a tendon graft — tendon tissue that is taken (harvested) from another part of your body — or even fusing the joint straight.

An orthopedic surgeon should be consulted in making the decision to treat this condition surgically.

Mallet finger – NHS – NHS

Mallet finger is an injury to the end of your finger that causes it to bend inwards towards your palm.

You will not be able to straighten the end of your finger because the tendon connecting the muscle to the finger bone is stretched or torn.

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Your finger will also be painful and swollen. In some cases, the tendon does not tear, but a small fragment of your finger bone breaks off where the tendon is attached.

Mallet finger is a common sports injury. It can also happen after catching your finger on something.

When to get medical help

Go to your nearest minor injuries unit as soon as possible if you think you have mallet finger. You’ll need to have your finger splinted.

Try to keep your hand raised until a doctor sees you. This will help reduce any swelling and pain.

If you wear a ring on the affected finger, you should remove it. The swelling might make it difficult to remove the ring later, or the ring may cut off the blood supply to your finger.

You can take an over-the-counter painkiller, such as paracetamol or ibuprofen, to help relieve the pain.

Once your finger is splinted, applying an ice pack that’s wrapped in a towel, a few times a day for 10 to 20 minutes, may also help reduce the pain and swelling.

Treating mallet finger

Your finger will be put in a plastic splint, which keeps it straight, with the end joint slightly bent backwards. You’ll still be able to bend your finger at the middle joint.

The splint is taped on and must be worn day and night for 6 to 8 weeks to allow the 2 ends of the torn tendon to stay together and heal. It should only be removed for cleaning.

It’s very important that the end of your finger does not bend during the time it’s splinted because it may slow the healing and reduce the effectiveness of the treatment.

The middle joint of the finger is left free so you can continue to move it to prevent any stiffness developing.

Surgery is only needed if you also have a broken finger, the skin is broken, or in rare cases where mallet finger fails to heal.

How to keep your finger clean

You must keep your splinted finger clean and dry at all times. If the skin inside the splint gets wet it will become very sore.

It’s important to wash both your finger and the splint at least once a day, following these instructions:

1. Keep your finger flat on a table, cut the strapping, and slide the splint off your finger.
2. Wash and dry your finger and the splint using soap and water. Keep the end joint straight at all times by keeping your finger flat on the table. It may be easier if someone helps you to do this each day, as any movement of the end of your finger will delay the healing of the tendon and may even cause permanent damage.
3. Slide the splint back over your fingertip, keeping your finger straight.
4. Replace the strapping – this should cover the middle of the splint but should not cover the middle joint of your finger.

Recovery

It should take 6 to 8 weeks for your finger to heal, after which time you’ll be able to use it again. You may be advised to continue to only wear the splint at night for up to 4 more weeks.

In some cases, you may only need to see a specialist once, as a hand physiotherapist may be able to take over your care. They’ll give you exercises to do at home to help prevent your finger becoming stiff.

Depending on your job, you may need to take some time off work. You should also avoid sports involving the hands while your injury is healing.

It may take several months for your finger to become fully functional. Redness, swelling and tenderness of the skin around the end of the finger are common for 3 or 4 months after injury but usually settle eventually.

You may be left with a small bump on the top of the joint and be unable to fully straighten the joint. Your finger may not be exactly the same as it was before the injury, but overall, it should function well.

Page last reviewed: 09 March 2020
Next review due: 09 March 2023

How Can You Treat a Mallet Finger?

A mallet finger, sometimes called “baseball finger” or drop finger, is caused by an injury to the tendon at the tip of the finger that causes the finger to remain bent and only be straightened with assistance. It’s frequently caused by jamming your finger.

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After the injury has occurred, you may notice that the tip of your finger “drops” and you are unable to fully straighten it. This may seem like a minor problem, but if it isn’t treated properly, it can lead to long-term problems.

Mallet Finger Symptoms

A mallet finger is an obvious injury, if you know what you’re looking for: the last joint of the finger will be bent down, and while you can push the tip up with your other hand, the finger won’t fully straighten on its own.

When you first hurt your finger, it can be quite painful, but the pain tends to drop off fairly quickly. Most people with a mallet finger are tender at the site of the injury, just behind the base of the fingernail. Due to minimal pain, many mallet fingers go undiagnosed for weeks or longer, because people are unaware of the significance of their injury.

In some people, when the tip of the finger is struck quite forcefully, there may also be injury to the fingernail, and the underlying nail bed. Often there is bruising noted underneath the fingernail.

Depending on the amount of blood that accumulates, this can lift up the fingernail, and in some situations, the fingernail may fall off, although this is unusual.

If you cannot fully straighten the finger, or if there is a deformity of the finger, that is a reason to have your finger injury evaluated by a trained medical provider. Always take it seriously when an injury leads to your finger not looking normal or bending properly.

Causes

A mallet finger is an injury to the extensor tendon on the back of the finger, which is the tendon used to straighten the digit.

The tendon has several attachments on the back of the finger, including one just beyond the last knuckle that allows this last finger joint to extend (straighten). When the tendon is injured, there is nothing to pull that last knuckle straight, and therefore, the joint stays bent.

Some of the common causes of a mallet finger include:

• Sports injuries in which a ball hits the end of the finger (hence the name baseball finger)
• Falls in which you to land on your extended finger

Less often, a minor force like tucking a bedsheet under the mattress can cause enough damage to result in mallet finger. While “jamming” your finger is the most common cause, you can also get mallet finger from cuts, crushing injuries, or a deep abrasion.

Diagnosis

Diagnosing mallet finger is fairly simple, since it’s a pretty obvious injury. Doctors will examine the finger and typically perform an X-ray to assess the finger joints and the bones. Most mallet fingers cause damage only to the tendon, so the X-rays will look normal, but it is important to rule out any associated injuries.

Treatment

Most of the time, even if treatment is delayed, mallet fingers can heal in about eight to 12 weeks with just a simple splint.

A Stack splint is the easiest type of splint to use for this injury. It is shaped like your fingertip and slips over your finger to below the level of the joint. You can find ones that are clear or are flesh-colored.

If you take the splint off and allow your finger to bend before it’s healed, the treatment will probably have to be restarted from the beginning. Since a Stack splint is usually worn for four to eight weeks, this can be a significant challenge.

If you do take off the splint for any reason (such as to clean it), make sure you don’t allow your finger to bend. With a splint in place and the fingertip kept straight, there should not be significant discomfort.

While no one wants to be in pain, the lack of pain is often a problem, as it makes it easy to be less careful than you should be about proper treatment and splinting techniques.

When Surgery Is Necessary

Some situations may require surgical intervention. Most mallet fingers are an injury to the tendon itself, but in some cases, the tendon may pull off a small fragment of bone from the finger bone. This is called bony mallet finger. If the bone fragment is large enough, it may require surgical treatment to prevent joint problems from developing.

Surgery may also be needed in situations where the injury is left untreated for more than four to six weeks and problem called a swan-neck deformity develops. Because the tendon that straightens out the tip of the finger is pulled back, more force is acting on the first knuckle of the finger.

This abnormal force creates hyperextension of that knuckle and can lead to deformity over time. Sometimes, a swan-neck deformity is a cosmetic issue, leading to no significant functional problems. In other cases, though, it can impair your finger’s normal function.

A Word From Verywell

A mallet finger is more than just a typical jammed finger. Without proper treatment, permanent deformity can be the result. Fortunately, most people can heal this injury with the proper use of a simple splint.

Having this injury evaluated and properly treated is critical to the successful recovery from a mallet finger injury. Not having proper treatment can lead to permanent deformity.

Mallet Finger (Baseball Finger)

What is Mallet Finger?

A mallet finger is a deformity of the finger caused when the tendon that straightens your finger (extensor tendon) is damaged. When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon that straightens the finger (see Figure 1a and 1b). The force of the blow may even pull away a piece of bone along with the tendon (see Figure 2). The finger or thumb is not able to straighten. This condition is also sometimes referred to as baseball finger.

Figure 1a and 1b:   The pictures above show an example of mallet finger with drooping of the tip

Figures 2a and 2b: X-rays of Mallet Fingers, note drooped posture of finger tip.  Figure 2a shows fracture fragment where the extensor tendon is attached.  Figure 2b shows intact bone, injury is to tendon only.

Symptoms

The key finding with a mallet finger is that the fingertip droops; that is, it cannot straighten on its own power. The finger may be painful, swollen and bruised, especially if there is an associated fracture, but often the only finding is the inability to straighten the tip. Occasionally, blood collects beneath the nail. The nail can even become detached from beneath the skin fold at the base of the nail.

Diagnosis

The diagnosis is evident by the appearance of the finger. X-rays are often ordered to see if you have pulled off a piece of bone and to make sure the joint is aligned.

Nonsurgical Treatment

The majority of mallet finger injuries can be treated without surgery. Ice should be applied immediately, and the hand should be elevated (fingers toward the ceiling.) Medical attention should be sought within a week after injury. It is especially important to seek immediate attention if there is blood beneath the nail or if the nail is detached. This may be a sign of a nail bed laceration or an open (compound) fracture.

There are many different types of splints/casts for mallet fingers. The goal is to keep the fingertip straight until the tendon heals. Most of the time, a splint will be worn full time for eight weeks (see Figure 3). Over the next three to four weeks, most patients gradually begin to wear the splint less frequently. The finger usually regains acceptable function and appearance with this treatment. Nevertheless, it is not unusual to lack some extension at the conclusion of treatment. Your surgeon will instruct you about how to wear the splint and will also show you exercises to maintain motion in the middle joint (proximal interphalangeal joint) so your finger does not become stiff. Once your surgeon feels your mallet finger has healed, he/she will show you exercises to regain motion in the fingertip itself.

Figure 3 : Splint supporting tip in extension

In children, mallet finger injuries may involve the cartilage that controls bone growth. The doctor must carefully evaluate and treat this injury in children, so that the finger does not become stunted or deformed.

Surgical Treatment

Surgical repair may be considered when mallet finger injuries have large bone fragments or joint mal-alignment. In these cases, pins, wires or even small screws are used to secure the bone fragment and realign the joint. Surgery may also be considered if non-surgical treatment is not successful in restoring adequate finger extension. Surgical treatment of the damaged tendon can include tightening the stretched tendon tissue, using tendon grafts or even fusing the joint straight. Your surgeon will advise you on the best technique in your situation.

Download a PDF on Mallet Finger

Current concepts: mallet finger

Hand (N Y). 2014 Jun; 9(2): 138–144.

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Sreenivasa R. Alla

Department of Orthopedics, University of Virginia, Charlottesville, VA 22903 USA

Nicole D. Deal

Department of Orthopedics, University of Virginia, Charlottesville, VA 22903 USA

Ian J. Dempsey

Department of Orthopedics, University of Virginia, Charlottesville, VA 22903 USA

Department of Orthopedics, University of Virginia, Charlottesville, VA 22903 USA

Corresponding author.Copyright © American Association for Hand Surgery 2014This article has been cited by other articles in PMC.

Abstract

Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment.

Keywords: Mallet finger, Bony mallet finger, Soft tissue mallet finger

Injury to the extensor mechanism at the distal interphalangeal (DIP) joint can lead to mallet finger also known as “baseball finger” or “drop finger.” This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon (Fig. ). Mallet finger leads to an imbalance in the distribution of the extensor force between proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger can lead to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment. This paper will review the current treatment guidelines for the surgical and non-surgical management of mallet finger.

Lateral of small finger bony mallet with minimally displaced small osseous fragment

Incidence

The incidence of bony mallet finger is well reported in the literature [7], but there is no published data regarding the incidence of soft tissue mallet finger. Mallet finger injuries are most commonly seen in young and middle aged male patients. The mean age for males is 34 compared with 41 in females. Seventy-four percent of bony mallet finger injuries involves the dominant hand, and more than 90 % of injuries was found in the ulnar 3 digits [51]. Schweitzer and Rayan determined in a kinematic study of the terminal extensor mechanism that the long finger is at greatest risk for mallet deformity; this was based on its significant increased flexion deformity of the DIP joint with each one millimeter increase in length of the terminal tendon. As little as 1 mm of terminal tendon lengthening resulted in −25° of DIP joint extension lag. This means adjusting exact tension during surgical intervention is crucial for preventing mallet deformities.[40]. Jones et al. did an epidemiological study of 24 members of a family over three generations and proposed a familial predisposition to develop the mallet finger deformity [20].

Mechanism of Injury

The most common mechanism of injury in mallet finger is a sudden flexion of the DIP joint with the resistance force directed along the long axis of the finger [43]. This leads to terminal extensor tendon tear or tendon avulsion with a bony fragment. In athletes, it is commonly seen with a forceful blow to the tip of the finger causing sudden flexion. Baseball players typically present to their provider with the diagnosis of a “jammed” finger [6, 51]. Open injuries are caused by a laceration, crush, or deep abrasion. DIP joint hyperextension can cause mallet finger secondary to a dorsal lip fracture as the hyperextended distal phalanx impacts on the head of the middle phalanx [26].

Classification

Patel and Gerberman defined acute mallet fingers as those presenting within 4 weeks of injury and chronic mallet fingers as those presenting after 4 weeks of injury. Several classification systems have been described for mallet fingers [13, 37].

The most widely recognized classification system for bony mallet finger is the Wehbe and Schneider classification system [51]. They divided the mallet fractures into three types and each type is subdivided into three subtypes depending on the degree of articular involvement. Wehbe and Schneider recommend operative treatment for type II subtypes B and C given its degree of articular involvement. However, except for irreducible injuries, results from Wehbe and Schneider demonstrated that surgical versus non-surgical treatment did not influence final results (Table ).

Table 1

Wehbe and Schneider classification

Doyle proposed a classification for soft tissue and bony mallet fingers based on the mechanism of injury [11]. Type I is a closed trauma resulting in a tendon avulsion with or without a small fracture fragment, Type II is an open laceration with tendon discontinuity, Type III is a deep abrasion with loss of tendon continuity, and Type IV mallet finger includes three subtypes: A—trans epiphyseal fracture, B—hyper flexion injury with 20–50 % articular involvement, and C—hyper extension injury with more than 50 % articular involvement.

Treatment

There are several treatment options for mallet finger. Many splint configurations and surgical techniques have been described over the past several decades. However, the optimal treatment of each type of mallet finger injury remains controversial. Splinting is the most common initial treatment method for soft tissue or bony mallet finger. Regardless of the treatment option, common sequelae include a slight extensor lag and a prominent bump on the dorsum of the finger [6].

A mallet finger treatment outcome assessment classification was proposed by Crawford [8]. It is the most commonly used classification for outcome assessment after mallet finger. An excellent outcome is no pain with full range of motion at the DIP joint, less than 10-degree extension deficit is a good outcome, 10–25 degrees of extension deficit with no pain is a fair outcome, and more than 25 degrees of extension deficit or persistent pain is considered a poor outcome.

Most surgeons believe closed/non-operative treatment using splints produces satisfactory results for tendon avulsions without fracture and minimally displaced or small fractures [19, 34]. Makhlouf and Deek have considered surgery when splinting cannot correct acute deformities; however, we will review the present literature for acute open and chronic deformities.[31].

Acute Mallet Finger

The authors feel non-operative management of mallet finger is indicated in cases of all soft tissue mallets and bony mallets which are well reduced in a splint without DIP joint subluxation. Immobilization of both the PIP and DIP joints was previously thought to be necessary to relax the extensor hood and intrinsic musculature during terminal extensor tendon healing. Katzman et al performed a cadaveric study to determine whether PIP joint motion would cause a tendon gap at the immobilized DIP joint. They demonstrated that gapping of a disrupted terminal extensor tendon occurred as a result of excursion of the distal tendon stump during DIP joint flexion, not because of retraction of the proximal portion of the tendon with simulated PIP joint extension. They concluded that only the DIP joint need be immobilized in extension to allow healing of the mallet injury. Most authors currently advocate immobilization of the DIP joint alone [23].

Splinting

There are many variations in the design of splints, but the principle is the same (Fig. ). All mallet finger splints are designed to maintain full extension or slight hyperextension at the DIP joint. Commonly used splints are plastic stack splints, thermoplastic, and aluminum form splints. The authors recommend full time splinting for 6 weeks, followed by 2–6 weeks of splinting at night (Fig. ). The splint should be used continuously and the DIP joint should be maintained in full extension even during skin hygiene care [13, 14]. Patients should be instructed on how to change the splint for periodic cleaning and examination of the skin without allowing the DIP joint to flex. Neglecting a mallet injury or incorrect treatment can lead to DIP joint dysfunction. 1 mm lengthening of the terminal extensor tendon results in 25 degrees of extension lag, and a shortening of 1 mm will seriously restrict DIP joint flexion [40].

Assorted splints utilized for non-operative treatment of mallet finger

Non-operative treatment using a plastic stack splint of a bony mallet at day after injury (a) and 6 weeks (b)

Okafor et al reported on 31 patients treated conservatively using splints with 5-year mean follow-up and found high patient satisfaction despite an average 8-degree extension lag [36]. Gerberman et al showed that even delayed splinting of a mallet finger at an average of 53 days from injury resulted in a successful outcome with or without the presence of a small fracture defined as <30 % of articular surface. O’Farrell et al. described a sterile intra-operative splint system for surgeons to maintain and perform surgeries [35].

There are several studies comparing mallet finger splints. Perforated splints are better tolerated than solid stack splints [24]. Aluminum-alloy malleable splints are associated with more skin complications as compared with the stack splint, but final outcomes are similar [30]. Warren compared the use of the Abouna splint (rubber coated wire splint) versus the stack splint in a randomized study involving 116 patients. The Abouna splint had skin complications and poorer patient satisfaction but similar final outcomes as compared with the stack splint [50]. Pike et al. compared the clinical and radiographic extensor lag measurements for mallet fingers treated with volar, dorsal, and custom thermoplastic splinting. There was no extensor lag difference between splints at 12-week follow-up and increased extensor lag was noted with all three splints after discontinuation at 6 weeks of time [38].

Stern and Kastrup reported a 45 % complication rate with non-operative splint treatment. These complications were usually transient and in the form of skin ulcerations [44]. Some extensor lag is likely with splint treatment, but this does not appear to result in patient dissatisfaction or functional deficit [32, 36].

Operative Treatment

Surgery is controversial in closed acute mallet finger but is indicated in all open injuries and in injuries with a large bony mallet fragment with subluxation of the DIP joint [50]. Fractures involving 30–50 % of the joint surface have been described as unstable and require surgery [17, 51]. Surgery is also indicated in patients with intolerance to splints.

Several different surgical techniques have been described in the literature: Kirschner wiring, extension block wiring (Fig. ), small screws, hook plate, pull-through wires, figure of eight wiring, tension band wiring, umbrella handle k-wire fixation, and external fixation [2, 3, 10, 12, 16, 21, 25, 27, 39, 45–48, 52]. Reduction and fixation of the avulsion fragment can be performed by closed or open means. Extension block k-wire pinning is usually performed by closed methods while screws, hook plate, tension band, and pull through sutures are usually performed using an open technique. Patients treated with k-wire fixation had an average flexion range of 55 degrees and extension lag ranging from 0 to 20 degrees [29]. Damron conducted a biomechanical study that compared four different fixation techniques—k-wires, figure of eight wiring, pull through wire, and pull through suture. Pull-through sutures are bio-mechanically more stable with no loss of reduction when compared to other techniques [9].

Lateral and oblique radiographs of a small finger bony mallet pre-operatively (a, b), post-operatively (c, d), and approximately 8 weeks post-op demonstrating bony union. K-wires were removed at 5 weeks (e, f). The procedure was performed using the extension block technique with 0.45 mm k-wires

Splint Versus Surgery

Stern and Kastrup retrospectively reviewed 123 mallet fingers: 45 intra-articular fractures, 37 avulsion fractures, and 39 tendon injuries. Seventy-eight patients were treated with splints and 39 were treated with surgery. Splinting was the preferred treatment in this study because there was a high complication rate (53 %), including infection, nail deformity, joint incongruity, and fixation failure in the surgically treated patients [44].

In uncomplicated acute cases of mallet finger, splinting appears to be as effective as surgical intervention. In a prospective randomized trial with 41 patients, no differences were found in outcome between external splinting and internal fixation [1]. Lubahn reported a prospective cohort study of 30 mallet fractures treated with either splinting or surgery. He suggested that open reduction and use of smaller kirschner wires provides a cosmetically and functionally superior result in select cases [29]. Even with a recent meta-analysis by Handoll and Voghela, there was insufficient evidence to determine when surgery is indicated [15]. He suggested that the splint must be strong enough to withstand everyday use but patient compliance is necessary for non-operative treatment.

Complications

Both non-operative and operative treatments are not without complications. The most frequent complications were dorsal skin complications (ulceration, maceration, nail deformity) and recurrent flexion deformity. Some extensor lag is likely with operative treatment and splinting, but it does not appear to result in patient dissatisfaction or functional deficit [32, 36]. Up to a 45 % complication rate with splints has been described by Stern. These complications were mostly skin related and were almost always transient. A 52 % complication rate (infection, nail deformity, joint incongruity, implant failure, and residual pain) has been reported with k-wire fixation [44]. Open reduction and pull-out wire fixation is associated with a 38 % complication rate including, nail deformity and implant failure [44]. In a study by Bischoff, 51 patients with bony mallet finger injuries fixed with tension band wiring were studied. At the 14-month follow-up, 24 patients had complications including dorsal skin breakdown, infections, displacement of fractures, and avascular necrosis and extensor tendon rupture [4].

Acute Open Mallet Finger

Management of open mallet finger injuries is described in very few publications. Nakamura and Nanjyo hypothesized that the large DIP joint extension deficits in some open mallet finger injuries were caused by disruption of both the terminal extensor tendon and contiguous oblique retinacular ligaments. In these injuries, they found extension deficits ranging from 25 to 70 degrees. Allowing the extensor tendon to heal by bridging the scar with splinting was thought to predispose the digit to a DIP joint extensor lag and secondary swan neck deformity. Open surgical repair was recommended, using figure of eight stainless steel wiring and k-wire immobilization of the DIP joint for 3 weeks [32]. Doyle suggested a combination of surgical repair and splinting for acute tendon lacerations overlying the DIP joint. His technique involves a running suture to re-approximate both skin and tendon, followed by application of an extension splint. The suture is removed after 10 to 12 days, with splinting continued for 6 weeks [11]. Open mallet finger injuries require thorough irrigation and debridement before tendon repair. The lacerated tendon may be repaired separately or the tendon may be sutured incorporating the skin (tenodermodesis). Tendon reconstruction may be delayed if there is gross contamination. In these circumstances the DIP joint should be immobilized until definitive surgery. Open tendon injuries with a segmental tendon defect may require primary reconstruction or delayed reconstruction depending on the contamination.

Chronic Mallet Finger

A mallet deformity is considered chronic when splinting cannot correct the injury or more than 4 weeks has passed from the injury [13, 37]. Mallet injuries that present 4–8 weeks after injury without a fixed deformity should initially be treated with splints [13]. Surgery is usually considered in cases not receptive to splinting, if there is an extensor lag of 40 degrees, or if there is a functional deficit [22, 41]. Surgery is contraindicated if there is a fixed deformity of the DIP joint.

The two most commonly reported techniques for chronic mallet finger are tenodermodesis and central slip tenotomy as described by Fowler [22, 41]. Tenodermodesis consists of excising part of the tendon and skin over the DIP joint, then repairing the full thickness defect with non-absorbable sutures. The DIP joint is placed in extension and immobilized by internal fixation and/or splinting. Sorene and Goodwin reported a mean decrease of extension lag from 50 degrees to 9 degrees, with a mean follow-up of 36 months [42].

The aim of tenotomy of the central slip is to rebalance the extensor mechanism by transecting the insertion of the central slip, thereby transmitting increased extensor force and excursion to the terminal tendon. Bowers and Hurst utilized tenotomy of the central slip and demonstrated excellent results with full extension in 4 out of 5 patients. None of these patients had a bony component to their injury [5]. In a study by Houpt et al., 26 of 35 patients regained full extension after tenotomy whereas 8 patients had a residual deformity of 10–20 degrees and one patient with 30 degrees [18].

In a recent review article by Makhlouf, limiting surgery to the DIP joint is a reasonable option by converting the closed chronic mallet finger into an acute open mallet finger and suturing the tendon back using a suture anchor. It appears that creating an injury significant enough to stimulate healing potential is crucial to this technique [31]. This was demonstrated in a study by Ulker et al. where 22 patients with chronic mallet fingers underwent open fixation by suture anchor. Post-operatively, 15 of 22 patients had excellent results which included no pain, satisfactory cosmetic appearance, and active extension/flexion at the DIP joint that was equal to that of the uninvolved contralateral joint [31, 49].

Conclusions

All acute reducible bony or soft tissue mallet fingers are best initially treated with splints. Bony mallet fingers with more than 30 % articular involvement with joint subluxation are better managed surgically. Acute open mallet fingers and chronic mallet deformities, after failing a trial of splinting, are best managed surgically. There are a large number of comparative studies for splints versus surgery, but more comparative studies are needed to determine which cases respond best to surgical intervention. Some extensor lag is expected after treatment whether splint or surgery, but extensor lag does not correlate with patient satisfaction. Complications must be carefully considered when surgery is contemplated.

Conflict of Interest

Sreenivasa R. Alla declares that he has no conflict of interest.

Nicole D. Deal declares that she has no conflict of interest.

Ian J. Dempsey declares that he has no conflict of interest.

Statement of Human and Animal Rights

This article does not contain any studies with human or animal subjects.

Statement of Informed Consent

This article does not involve any patients and does not need informed consent.

References

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Mallet Finger | Orthopaedic Associates

What it is

Mallet finger is an injury which leads to disruption of the extensor tendon as it inserts into the tip of your finger. It can occur in any finger. The disruption can either be the tendon ripping off the bone (soft tissue mallet), or the tendon ripping a piece of bone off with it (bony mallet fracture). It usually occurs when the end of the finger gets “jammed” by a ball or a solid object such as a wall or the floor. If a mallet finger is not diagnosed and treated appropriately, it can lead to further deformity in the finger.

Symptoms

A mallet finger injury usually causes pain and swelling immediately in the finger. The patient will notice that the last joint in their finger, the distal interphalangeal joint, will droop down as they lose the ability to extend it actively.

Non Surgical Treatment

Most mallet finger injuries, both soft tissue and bony, are best treated with non operative splinting. This is done with a small splint which holds the joint extended but allows the rest of the finger to move to prevent stiffness in other joints. The splint must fit very well and is usually custom made by a hand therapist. The splint is worn for 6 weeks and must remain on 100% of the time. Any flexion of the joint will cause tearing of any new healing tendon. Because of this, patients usually need more than one splint so that they can bathe and then change the splint out for a dry one while holding the finger straight. After 6 weeks of full time splinting, the splint is worn at nighttime for 6 weeks. The expectation is that patients will have minimal drooping or “lag” in the joint at the end of treatment.

Surgical Treatment

There are a few situations in which surgery is necessary for a mallet finger. If the non operative splinting is not effective or the patient is unable to be compliant, a pin can be surgically placed into the finger to hold the joint in extension. This is sometimes necessary if people have jobs which require constant hand washing and therefore wearing a splint is not feasible. Pinning may also be necessary in bony mallet fractures which include a large part of the joint surface or lead to joint instability. These are all factors that are best assessed by a qualified hand surgeon. In any case, surgery is performed as an outpatient under local anesthesia with or without mild sedation based on patient comfort. General anesthesia is usually not necessary.

Post-operative Recovery

The pin usually needs to be protected with a custom made splint. The pin is removed after 6 weeks in the clinic by your surgeon. This is not very painful at all. Nighttime splinting is then done for 6 weeks. Formal therapy is usually not necessary.

If you have suffered a mallet finger, give our office a call today to get in and be evaluated. 715-847-2382.

All Images Copyright American Society for Surgery of the Hand

The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury

Thirty-six patients each with an acute closed mallet finger injury (age range: 12–56 years; mean age: 32.2 years) referred to the orthopaedic department of our hospital from Sep 2009 to Jul 2015 were included into this study. The study protocol was approved by the ethics committee of Shandong Medical Imaging Research Institute and all methods were performed in accordance with the relevant guidelines and regulations. All participants provided written informed consent. All presented with a flexion deformity of a single finger at the distal interphalangeal joint (DIP). Duration of symptoms reported by the patients varied from 1 day to 2 weeks. Detailed clinical and imaging examination data was summarized in Table 1.

Table 1 The detailed clinical profiles and image examination for mallet finger.

All patients underwent ultrasonography, X-ray, and MRI examinations. All the ultrasound examination was performed by an experienced cardiovascular ultrasound expert with more than 7 years of experience in cardiovascular ultrasound examination. Ultrasonography, X-ray and MRI images of the 36 cases were all assessed by two musculoskeletal radiologists blinded to the clinical diagnosis independently, with more than10 years of imaging diagnosing experience in interpreting X-ray, ultrasound and MRI examination results. Reference to original imaging reports was shielded to avoid bias.

A GE Vivid7 ultrasound system (GE healthcare, Holten Norway) with a 14 MHz broadband linear array probe (GE healthcare, Holten Norway) was used for ultrasonography examination. During the examination, a thick layer of gel or a small water sac was applied for better observation result. Both a static and a dynamic ultrasonography examination with longitudinal and axial sonograms were performed on the injured finger focusing of the extensor tendon insertion site on the base of the distal phalangeal bone. The static examination was performed with the injured finger in neutral position, while the dynamic examination was carried out by intended active and passive moving DIP joint and observing the real-time imaging of the extensor system, with a comparison with the contralateral healthy finger for the purpose of control.

Besides of observing the digital extensor tendon, base of the distal phalanx was carefully checked during the ultrasonography examination, as well as on X-ray and MRI images to exclude fracture. Non-contrast MRI images of T1WI and T2WI sequences in both axial and longitudinal plane were obtained using a 3.0 Tesla MRI system(GE Signa EXCITE HD 3.0 T, The USA) with a dedicated surface coil on the injured finger and the contralateral healthy finger, for the purpose of control. The ultrasonography, X-ray and MRI results of each case were summarized in Table 2 and Table 3.

Table 2 The image examination results of acute closed mallet finger (radiologist A).
Table 3 The image examination results of acute closed mallet finger (radiologist B).

For evaluation of the extensor system injury, a new ultrasonography classification method of acute closed mallet finger injury was proposed in this study according to the type and location of the injury (extensor tendon injury or fracture of the distal phalanx):Type A, avulsion fracture without extensor tendon rupture. Type B, complete tendon rupture without fracture. Type C, contusion of extensor tendons.

And for the other hand, in order to identify the difference in terms of extensor tendon injury identification ability among the three examinations, the images were classified into four grades according to the tendon and border with surrounding tissue appearance. Grade 0: the injured extensor tendon could not be identified. Grade 1: the injured extensor tendon was showed with poor detail. Grade 2: relatively clear identification of the injured extensor tendon quality. Grade 3: any slightly thin fiber bundles of the injured extensor tendon was visible with a good detail. Corresponding injured extensor tendon evaluation results were summarized in Table 4 and Table 5.

Table 4 The visibility of extensor tendon in the three examinations (radiologist A).
Table 5 The visibility of extensor tendon in the three examinations (radiologist B).

In addition, in order to identify the difference in terms of bony fragment identification ability among the three examinations, the images of 9 cases with avulsion fracture of the distal phalangeal base were classified into another four grades according to the bony fragment border with surrounding tissue appearance as well. Grade 0: bony fragment could not be identified. Grade 1: bony fragment was found with poor detail. Grade 2: bony fragment was relatively clear. Grade 3: a bony fragment was clearly visualized with a good detail. All bony fragment evaluation results were summarized in Table 6 and Table 7.

Table 6 The visibility of fracture fragment in the three examinations (radiologist A).
Table 7 The visibility of fracture fragment in the three examinations (radiologist B).

The SPSS program (version 13.0, SPSS, Chicago, IL, USA) was used for statistical analysis. Kappa test was adopted to evaluate the inter-rater reliability for the original classifications. Kruskal-Wallis test was adopted to find statistical difference between identification ability of extensor tendon injury among the three examinations and difference between identification ability of bony fragment among the three examinations, and the Bonferroni method for multiple comparisons (α′ = 0.05/[3(3-1)/2] = 0.017). Paired t-test was used to find statistical difference of the average measured diameter of the extensor tendon between acute closed mallet fingers and contralateral fingers.

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Hammer on alarm what it means

No one has argued about the benefits of security systems for a car for a long time.
The question: to put or not to put, this is a somewhat different discussion.

Almost all modern cars are already equipped with an immobilizer at the factory, and some with alarm systems.

But given our Russian climatic conditions, we often really want autostart. It’s nice to get into an already warmed up car and a warm interior without wasting time to warm up.

Car alarms are now sold in many, even in non-specialized car dealerships.
In this article, we will consider such a nuance as using an alarm without an instruction manual.

Quite often, when purchasing a car on the secondary market, the buyer receives an already installed alarm system and very often without instructions for use.

Our people are knowledgeable and competent without any instructions, and therefore they don’t bother too much.

However, in addition to universal literacy, our people are curious and meticulous.

Turning the signaling keychain in your hands and looking at the letters and symbols, the question arises: “What do they mean?”

Designations for all manufacturers are almost the same and without finding instructions for the system that you have (which is at least strange with the current omniscience of the Internet), you can take a description from another.

Basic symbols on the car alarm key fob.

Magicar

key fob is taken as an example

Apart from the battery level, signal level, clock and the like, other special symbols are actually quite intuitive as well.

• “The lock is closed” – the car is guarded.
• “The lock is open” – the car is disarmed.
• “Car trunk open” – opening the trunk lid without disarming the doors.
• “Hammer” – the shock sensor has been triggered.
• “Smoke coming out of the chimney” – accordingly, the engine is running.
• “Key” – service mode.

Main symbols on the car alarm key fob display and their decoding

But the best option is, of course, to receive the original instructions for your alarm.

It can also be obtained on the manufacturer’s website or, in extreme cases, ask the seller to scan (copy) the necessary pages.

In this article, auto repairman Aleksey Bakulin communicates with readers on the topic “What does the hammer on the alarm keychain mean?”

Hello everyone, tell me who can!
For the second day, the first level of the shock sensor has been triggered, triggered at different times. The keychain has the inscription SH-1 and a hammer. Until that time, there was no such problem, no one really walks near the car. While writing these lines, the sensor worked 2 times, before that the car stood for four hours and everything was quiet.
What to do?

Also overcame this problem, how to cure f … a fucking sensor? Where is he anyway? If you don’t know, I’ll find it and destroy it myself, no sleep, no rest for an exhausted soul))) All night this game entertained me until I extracted the resource of this attraction from under the hood … But this is not the case, an alarm is needed so that I I slept peacefully, and here it is, as it were, but it is better without it … On the one hand … And on the other, the car is not guarded …

For a note, I’ll tell you what; disabling the alarm with the remote control helps for a few minutes, after the car again turns on the siren mode, decided to set the silent mode by pressing: for a long time the first button on the remote control and after a short signal, shortly the second button, an icon appeared on the display but the problem did not dare, the machine did not emit a siren signal, but the remote control was torn to pieces telling me that the shock sensor was triggered.Then I noticed that the battery indicator on the remote control shows one division, although I put in a new, not cheap battery! I put the car on silent mode, and then I pulled out the battery from the remote control, it seemed like silence, you can sleep peacefully! Hence the thought, maybe a weak signal from the remote makes the signaling so buggy? We will understand and experiment

Hello AlexeyID.
A hammer is a shock sensor trigger.
Possible reasons lie in installation errors.
1. The sensor is fixed on the plastic and when the temperature drops, the plastic clicks and crunches, provoking the sensor triggering.
solution – transfer the sensor to metal – the most optimal place is the steering shaft cover tube or metal amplifiers in the panel. Re-adjust the sensor after transfer. It reacts most adequately to shocks in all planes if it is placed in space UNDER an INCLINATION to the horizon.
2. When installing the alarm, the communication module loop and the shock sensor loop were wound together.There is an induction to the inputs of the shock sensor zones during communication sessions and the passage of signals through the loop of the communication module.
solution – separate and rewire loops separately from each other. This information is generally known among installers and grows FROM THE MANUFACTURER’S RECOMMENDATIONS RECOMMENDATIONS for the C-series
For dialogue systems, this has become even more relevant.
3. More exotic installation errors are possible.
In any case, the installation must be rechecked. Car dealerships often sin with SPEED installation, which is poorly compatible with QUALITY.I recommend contacting the place of installation by printing out the information on the link and the text of this response. Maybe the installers of the car dealership are still not aware of the above.

Now about removing “garbage” from the screen. The simplest and safest thing is to press SHORT button 3 of the key fob. If there is a connection and the session will take place, then the temperature of the cabin will appear at the place of the clock and the CURRENT state of all armed zones will be displayed. If the shock sensor is not triggered at this moment, the hammer will disappear from the screen.It will also disappear when disarming / arming – that is, when executing any command, accompanied by a change in the picture on the screen.

the same people answer there)) if you are about the forum and you still need to register there (

dj0n,
no, I’m not talking about the forum, I’m talking about technical support specialists, they still come across these signals more often.

AA, yes !! I wrote to them, but I do not hope for their early reply (

sshuttle, and thanks for that: victory:

I will definitely try with the handbrake.And if that, where to look at these wires, if in the block, then I do not know yet where it is. Although in a couple of days I began to get used to 10 seconds.

One thing saddens that no one has canceled the car Gop_Stop, so I’m worried & # 128578;

Thanks all for the help!

Yes, I just don’t have the signaling connected to the brake. Slowly and painfully I get used to the 10 second wait & # 128578;

Thanks all for the help!

Yes, I just don’t have the signaling connected to the brake.Slowly and painfully I get used to the 10 second wait & # 128578;
don’t leave it like that. Let the installers connect the required wiring. This is necessary not only for the sake of this option, there is a hypothetical situation when, when the engine is running remotely (if there is an autostart), an intruder will penetrate inside, breaking, for example, glass, removed from the parking brake and set off. Well, this is such a scarecrow, in reality it may not happen.

I’ll squeeze into your conversation, I also have crap, and also weird. Signal StarLine B6.I read the manual, got acquainted with the FAK, but did not satisfy my question.
When programming the signaling functions, namely, closing the doors when incl. ignition. The manual contains four modes: 2nd – door closing. after 10 sec. after incl. ignition / open doors when off. ignition. The 3rd and 4th modes were programmed normally, but the 1st – none. It says that the doors close when the brake is applied, how is that? Click on the fagot. In short, the first one did not want to work. True, when off.ignition sound of opening the lock was present. Explain who is to blame. Service gnomes or my little experience of pressing the Valet button.
Summary: for me 10 sec. to close the doors too big, used to the last car immediately closed. And in my opinion, all women should ride with closed doors. Do not send in search, better help.
I already have a lot of questions & # 128578;
This is when, with the ignition on and the doors closed, you press the brake)) But installers often throw this wire to ground instead of connecting the brake)) It’s easier for them))

rezistors added 04.11.2009 at 09:14
Most likely the signaling is not connected to the brake. When I called the installers with the same problem, they said that they did not connect it on purpose. otherwise, the signaling “often starts to fail.” I then gave it up. and now I’m used to it.
They themselves are buggy)) These installers)) It’s just that when you connect it, if you don’t know, then the whitefish works right away and they stupid not understanding what the hell is this? And you need to refer to the instructions and everything will become clear))

————— By the way, when I kicked the wheel, the first shock sensor was snapped and the key fob squeaked.

99% someone or something jammed the signal. And the fact that the key fob showed triggers, so the signal transmitter power was read out more than the jammer power: aiwan01:

Very often, the owners of cars that have previously installed the security system “Starline” are faced with the problem of “false” alarm system. And it seems that the installation was recently purchased, and it seemed to work properly at first, but the Starline alarm shock sensor is still triggered, in those moments when there is no one around the car.Naturally, such cases cause a lot of inconvenience, and even a false signal causes stressful emotions.

We have already written why the alarm is sometimes triggered, but in this article we will try to figure out how to protect ourselves from such a fate, as well as correct the already existing problem situation. This material will contain the most common causes of false triggering of the sensor, their detailed analysis, as well as ways to solve this common problem.

If you suddenly have a problem, and the shock sensor of the starline alarm is suddenly triggered, you should understand the situation as much as possible and try to find the precursors.Is the alarm triggered by passing cars or not? The signal is triggered regularly or not, and if not, at what time of day? Sometimes there are cases when drivers noticed that the “Starline” was triggered at those moments when the handbrake was turned on. Having dealt with the precursors, and understanding the root cause of the signal call, you can understand the very essence of the problem and eliminate it.

The most common false positive problem is a misconfigured system. The exclamation of the car service employees who installed the protective platform, they say, “as soon as we put it, it worked! It means they themselves damaged … “, in this case they are inappropriate, so most often errors in the installation appear just after a while.

The increased sensitivity of the sensors can be corrected with your own hands, if you follow all the precautions and follow the generally accepted rules. Setting up the starline shock sensor can help in cases where the design of the sensors and the communication module has been violated. Such situations are caused by damage or prolonged wear of the protective systems.

The loops of the sensor and communication module can be located close to each other, while intercepting radio waves emanating from them and triggering a signal.If this is the case, try to separate them to an acceptable distance. Another common case is the improper fastening of the Starline platform itself. The material used is plastic, as the main fastener, can be broken due to deformations from impacts, or the effect of increased temperature. Therefore, you can get rid of false alarms by changing the mount to a metal base.

Very often, drivers complain about the alarm being triggered during wet weather: rain, fog, snow.The key fob displays a message about penetration into the car, or a blow on the door. The main reason for this phenomenon is called the ingress of moisture into the chains, which then short. To get rid of the problem, you should find out in which of the locks the condensate causes a reaction, and isolate it from moisture.

In addition, most irregularities can simply be caused by poor quality goods being delivered to you. “Long-livers” can be checked in a simple way: in the sensor settings, reduce the sensitivity to the minimum.Usually, in such situations, the signal is all early to pass, and such sensors must be replaced with serviceable ones.

Konovalov “in anger”, municipalities “in fear”

We have told more than once how the government of Khakassia disrupts national projects. It even ceased to be interesting, because as much as possible everything is about one and one thing.

Although … there is no action without consequences. And the general criticism (not only from our side) led to the fact that in the scheme of response to the situation of Valentin Konovalov, notes of irritation, claims, anger, counter attacks and, imagine, accusations appeared not typical for him!

Even if these notes are not very loud, the irritation is not very noticeable, the anger is modest, the attacks are barely noticeable, and the accusations are not bold, but there are some! They appeared, which means that something has changed.What?

We also thought about it, analyzed the last speeches of the head of Khakassia and came to the conclusion that somewhere in the bowels of our government it was decided to transfer the center of responsibility for disruptions in the delivery of facilities built thanks to national projects to the municipal level.

The idea that the republic is raising money in Moscow with sweat and blood, promptly transferring it to municipalities and creating all the conditions for construction to proceed normally is broadcast by all government channels.This is followed by the transmission of thoughts at a distance that municipalities in response do not fuss well, do not catch mice, break deadlines, work, and delivery of objects.

And for the sake of objectivity, we must say that Valentin Olegovich in this case is partly right. The leaders of the territories, elected by the people, really should not sit out trousers and skirts. They have to move, act, make decisions, sound the alarm if something goes wrong somewhere.

However, you and I know very well that the heads of municipalities are very different.Some, under any power, in any weather, under any circumstances, do everything right. Others, on the contrary, do everything backwards, regardless of power, weather and circumstances. Still others dangled their legs from the stool and took the position that the higher authorities should bring them everything on a silver platter.

This is so! Another thing is strange. Why Valentin Olegovich matured for so long to anger, claims and irritation. He is power! He is the head of the republic, so no one deprived him of the right to demand, control, correct, help, make organizational conclusions.

The very attempt to shift all the blame for the breakdowns onto the municipalities, as we have already said, even though it finds understanding, does not remove any responsibility from the head of the republic.

Initially, it was clear that many (especially in small settlements) would not cope with the requirements set by the federal center for the implementation of national projects. When there is no experience, knowledge, specialists, it is difficult to organize work on holding auctions, on creating projects, passing examinations and even a huge mass of licensing and control measures.

It is, of course, good that Irina Voinova has recently matured to initiate to engage in support of municipal projects. And it is, of course, great that during Tuesday’s government meeting on the implementation of the program for the development of rural areas, Valentin Konovalov said: “ Each object should have up-to-date information, also in a continuous mode. Where the document stopped. Where construction has slowed down. With the indication of surnames. We are conducting headquarters, pushing in manual mode.No need to wait for “. This is how the government media quoted him as saying.

Just where have you been before? We were waiting for the prices for building materials to rise several times before declaring that everything is in the hands of the federal center, and will they decide there?

But things are not solved that way. Everything is decided on the spot and not almost three years after the election. What’s the use of Konovalov now to show his small teeth, to run into the municipalities, to threaten them with exposure to the population, if it was necessary to resolve issues immediately and together.And all the levers of influence were constantly in the hands of Valentin Olegovich.

Only for some reason he always used them only as toothpicks, and not for the good of the case. And now he suddenly decided to show who is in power and who is the head of the republic!

Our ranks are constantly plagued by suspicions that the real head of Khakassia is Irina Voinova. And if now Valentin Konovalov has decided to debunk those suspicions, then it is better for him to do this not through rolling municipalities into the asphalt, but through real (not only announced) help to them …

Konstantin Obelensky

Door knockers or unusual door knockers 40 photos + – COMFORT IN THE HOUSE

Hello, dear readers! Nowadays, door knockers are rarely used, as they have been replaced by doorbells.But true connoisseurs of antiquity cannot exchange such a magnificent thing as a door knocker for a modern bell.

Although, in principle, the two objects sounded above can coexist quite successfully, and your guests themselves will decide whether to knock or ring the doorbell! But be that as it may, today we will focus specifically on door knockers.

What is a door knocker?

Traditionally, this device was fixed on the front door, in order to notify the owners about the guests who came, when a person comes to the door, he just needs to knock with this hammer and a loud, persistent sound will spread through the house! The item in question was made, and is still being made – from metal and most often has the correct ring shape, this ring, in general, knocks on a specially provided metal plate (it prevents damage to the door).Why a ring, everything is simple – it is convenient to take it with your hand, and it could also play the role of a door handle.

The appearance of door knockers was recorded in Ancient China, then they penetrated the territory of Venice, England and, of course, America, and after that they found approval in Russia. But it is worth noting that in our country such hammers could only be seen on the noble houses. Also, one cannot but say that today, door knockers are in demand mainly in America, and more often they perform only a decorative role, therefore they are made in non-standard, sometimes even eccentric shapes.