Juxta-articular phalanx fractures can present a challenge to the treating physician.  Goals of treatment include anatomic realignment, fracture stability and early range of motion.  Improper treatment can result in malunion causing deformity as well as joint stiffness.   Current treatment modalities can also result in unsatisfactory results including decreased range of motion.

The following case presentation provides a treatment alternative for the irreducible fracture normally requiring open intervention while satisfying the requirements of fracture stabilization and early range of motion.

A 35 yo RHD female presented to the office s/p injury to left long finger.  X-ray examination revealed a dorsally displaced juxta-articular fracture of the left  long middle phalanx.

Operative intervention is discussed.  It is agreed that CR will be attempted followed by intrafocal pinning.  This technique will provide fracture stabilization while allowing early mobilization.

 Attempts at closed reduction are often unsuccessful.  Traction is applied with unsuccessful attempt at volar translation of the fragment.

Under c-arm guidance, a 4.5 k wire is introduced at the fracture site.

It is used as a joystick to lever the fracture fragment to its correct, anatomical position.

Using the 4.5 to maintain reduction, percutaneous pinning will be performed using 3.5 K wires. First, directing one distal to proximal and radial to ulnar, the wire is inserted just proximal to the DIPJ.

The same process is repeated going from an ulnar to radial direction.

The 4.5 k wire is removed.  Anatomic reduction is confirmed and stability is verified under fluoroscopy.

The patient was dressed with sterile dressing and instructed to follow-up in 1 week. 

One week post-op, the dressings were removed and the patient was started on ROM at the PIPJ and DIPJ.

Four weeks post-op, the k wires were removed.  AROM at the time was 45 degrees at the DIPJ and 80 degrees at the PIPJ.  The patient was instructed to continue ROM exercises.