Abstract
The nonunion of distal phalangeal communized fracture is relatively rare in hand fractures. However, if it occurred, the surgical treatment is quite difficult because of small piece of fragmentations. We developed a new fixation method that involves the insertion of two wires and external wire compression fixation using a metal clamp. The aim of this technique was to increase the compression force between fragments and rigidity of conventional percutaneous Kirschner wire fixation. Here, we present a patient with the nonunion of distal phalangeal communized fracture who was satisfactorily treated with open reduction and percutaneous interfragmentary compression fixation with a linking external wire fixator (the Ichi-Fixator system). Such a treatment that enables compression fixation for communized distal phalangeal fracture of nonunion will clearly boost bone healing. Linked external wire-type compression fixator (the Ichi-Fixator system) enables enhanced security of fixation and facilitates the bone healing.
Highlights
Distal phalangeal fractures can be managed conservatively with good outcomes if diagnosed early
If the initial reduction is imperfect with total displacement between fragments such as communized fracture, it may be necessary to use headless screw or Kirschner wire (K-wire) for fixation after closed or open reduction
We developed a new linking wire type of external fixator that involves the insertion of two wires and external wire compressional fixation with special adjustable metal clamp fixation using small two inside screws [6]
Summary
Distal phalangeal fractures can be managed conservatively with good outcomes if diagnosed early. The treatment options for nonunion of distal phalangeal fracture include conservative management with use of ultrasound [1], bone graft with K-wire fixation [2], bone peg transplantation [3], and open reduction with internal fixation with a headless compression screw [4]. When left untreated, or if the reduction is incomplete, such injuries can lead to symptomatic nonunion, manifesting as chronic pain and/or instability To overcome these complications, we developed a new linking wire type of external fixator (the Ichi-Fixator system: Neo-medical, Saitama, Japan) that involves the insertion of two wires and external wire compressional fixation with special adjustable metal clamp fixation using small two inside screws [6]. We present a patient with nonunion of distal phalangeal fracture who was satisfactorily treated with open reduction and percutaneous fixation with the IchiFixator system
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