Dynamic External Fixation for Interphalangeal Comminuted Fractures With Mallet Injury

Margaret Luthringer, MD; Naji Madi, MD; Amanda Chow, BA; Ashley Ignatiuk, MD


ePlasty. 2021;21:ic2 

In This Article


A 26 year-old man presented with gunshot wounds to the left ring and small fingers. The physical examination revealed open, comminuted fractures of the middle phalanges of the left ring and small fingers; an extensor lag at the distal interphalangeal joint (DIP) of the small finger suggested a terminal tendon injury. X-ray imaging demonstrated a pilon fracture of the ring finger middle phalanx base with mid-shaft comminution. The small finger middle phalanx head sustained a comminuted fracture with bicondylar involvement. After debridement in the operating room, we fabricated dynamic external fixation devices for stabilization of the fractures of the ring and small fingers; dermatotenodesis was performed to address the mallet injury. The devices were removed at 6 weeks, where minimal stiffness was noted at the ring DIP and proximal interphalangeal joint (PIP) of the small finger during active ranging. The small finger DIP demonstrated active flexion to 30° at that time with no extensor lag.

Figure 1.

Patient 6 weeks after dynamic distraction and external fixation device placement.