The authors retrospectively reviewed 11 patients (11 fingers) who were treated for a symptomatic distal phalanx fracture nonunion with Kirschner wire fixation and cancellous bone graft harvested from the olecranon process. The injuries involved the distal phalanx base in 2 cases, the tuft in 2 cases, and at the shaft in 8 cases. At a mean follow-up of 7 months (range, 5-18 months), 10 fractures showed complete radiological union and 1 fracture showed partial union. A hematoma developed at the bone graft donor site in 1 case and subsided after drainage.
Incomplete bony consolidation of a tuft fracture is common and the resultant fibrous union is often well tolerated. In contrast, a symptomatic fracture nonunion of the distal phalanx is unusual (tuft, shaft, or base). There are limited reports of surgical management of these injuries with compression screw fixation, non-vascularized bone grafting, vascularized bone grafting, and amputation. The findings from this study support treatment of a symptomatic distal phalanx fracture nonunion with Kirschner wire fixation and autogenous cancellous bone grafting.