case_images: PMC10883261_01
case_images: Standard radiographs confirmed a displaced intra-articular fracture of the base of the middle phalanx with subluxation of the PIP joint. PIP, proximal interphalangeal
case_images: cureus-0016-00000052797-i01.jpg
case_images: PMC10883261_01_cureus-0016-00000052797-i01.jpg
case_images: FIG1
case_images: Standard radiographs confirmed a displaced intra-articular fracture of the base of the middle phalanx with subluxation of the PIP joint, consistent with a complex fracture-dislocation (Figure 1).
case_images: A volar approach with Bruner skin incision was used to expose the joint
case_images: cureus-0016-00000052797-i02.jpg
case_images: PMC10883261_01_cureus-0016-00000052797-i02.jpg
case_images: FIG2
case_images: Under regional anesthesia, a volar shotgun approach was used to expose the joint (Figure 2).
case_images: (A) Flexor tendons are retracted laterally (blue arrow) after incising the flexor tendon sheath and dividing the palmar plate distally and laterally. The finger is then hyperextended (shotgunned) to completely expose the fractured base of the middle phalanx (black arrow) and the head of the proximal phalanx. (B) A dorsal longitudinal incisional is taken over the carpometacarpal joint between the hamate and bases of the fourth and fifth metacarpals (black arrow). Hamate graft of appropriate size is harvested using an osteotome. (C) Graft was shaped and fixated onto the base of the middle phalanx using 1.3 mm cortical screws (black arrow).
case_images: cureus-0016-00000052797-i03.jpg
case_images: PMC10883261_01_cureus-0016-00000052797-i03.jpg
case_images: FIG3
case_images: The graft was meticulously shaped and fixated onto the base of the middle phalanx using 1.3 mm cortical screws, effectively reconstructing the articular surface (Figure 3).
case_images: Patient's index finger was immobilized for one week post-surgery
case_images: cureus-0016-00000052797-i04.jpg
case_images: PMC10883261_01_cureus-0016-00000052797-i04.jpg
case_images: FIG4
case_images: At the end of five months, the patient achieved 90 degrees of flexion and full extension with minimal discomfort
case_images: cureus-0016-00000052797-i05.jpg
case_images: PMC10883261_01_cureus-0016-00000052797-i05.jpg
case_images: FIG5
case_images: By the end of five months, he achieved 90 degrees of flexion and full extension with minimal discomfort (Figure 5).
case_images: Five months postoperative radiographs showing good alignment and integration of the graft, with no signs of resorption or joint degeneration
case_images: cureus-0016-00000052797-i06.jpg
case_images: PMC10883261_01_cureus-0016-00000052797-i06.jpg
case_images: FIG6