Abstract
Malunion of digital fractures can be difficult to correct especially for rotational phalangeal malunion. We describe the simple closed corrective technique.
Materials/Methods: Patients whose phalangeal fractures were treated closed (mobilised or POP +/− K wires) and malunited, typically with mal-rotation.
The technique is performed under LA. The bone is cut by percutaneous passage of a 1.1 mm K wire multiple times until the bone is fractured. The malunion is corrected and held with one longitudinal 1.1 mm K wire. The osteotomies are supported for 6 weeks in POP/splint and the wire(s) removed.
Results: 11 patients with 12 post fracture malunion–All metaphyseal osteotomies healed within 6 weeks with correction of malrotation and no significant angular deformity. The one diaphyseal osteotomy united late healing only partially (inadequately) corrected and requires revision. Apart from the malunion there were no major complications albeit short-term PIP joint stiffness.
Conclusion: This is a safe and reliable technique that avoids most of the complications of more challenging open techniques in the phalanges or the compromises of distant techniques e.g. metacarpal correction of phalangeal malrotation. It does however require immobilisation precluding any major simultaneous soft tissue releases. It appears unsuited to diaphyseal correction.
Correspondence should be addressed to David Bracey, Honorary Secretary c/o Royal Cornwall Hospitals Trust, Truro, Cornwall TR1 3LJ
