Malunions of the finger metacarpals and phalanges

Each metacarpal or phalangeal finger malunion must be evaluated. Extra-articular finger metacarpal malunions with greater than 3 to 4 mm of shortening or 30 degrees of dorsal angulation, and extra-articular proximal phalangeal fractures of the fingers with greater than 2 to 6 mm of shortening or 15 degrees of palmar angulation may require osteotomy. Rotational deformity of the fingertips of greater than 10 degrees causing digital impingement or overlap ("scissoring") may require correction, as may intra-articular malunions with greater than I to 2 mm of joint incongruity. Tenocapsulolysis may supplement corrective osteotomy. Adequate correction is achieved in most patients, but residual stiffness often persists. Nonunion or infection is rare. Reported complications are few, but their occurrence in individual patients should not be underestimated.