Functional and Radiological Outcome of an Open Comminuted Fracture of the Middle Phalanx Treated With Kirschner Wire Fixation: A Case Report

Resumen

Open comminuted fractures of the middle phalanx are challenging hand injuries because they are frequently associated with extensive bone comminution, soft tissue loss, contamination, and injuries to the flexor tendon and pulley system. The management of these fractures aims to achieve adequate debridement, stable fracture fixation, soft tissue reconstruction, prevention of infection, and restoration of hand function. Kirschner wire (K-wire) fixation remains a simple, minimally invasive, and cost-effective technique that provides satisfactory fracture stability while preserving soft tissue biology. We report the case of a patient with an open comminuted fracture of the middle phalanx who underwent emergency wound debridement followed by percutaneous K-wire fixation under fluoroscopic guidance. Associated injuries to the A5 pulley and flexor digitorum profundus (FDP) tendon were repaired during the same procedure. The patient received postoperative antibiotics, splint immobilization, and supervised hand rehabilitation. Radiological union was achieved at six weeks with maintenance of satisfactory alignment and no evidence of secondary displacement, malunion, or infection. Functional recovery was satisfactory with progressive improvement in proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint movements following physiotherapy. This case demonstrates that K-wire fixation, when combined with meticulous wound debridement, tendon repair, and structured rehabilitation, is an effective treatment option for open comminuted fractures of the middle phalanx, resulting in favorable radiological healing and good functional outcomes.