Border Digit Transposition and Intramedullary Nail Fixation for Third or Fourth Ray Amputation

Central ray amputation of the third or fourth finger leaves a gap between the remaining digits. This gap can allow small objects to fall out of the hand. The gap may be narrowed by suturing the remaining intermetacarpal ligaments or transposing the remaining border digit to the amputated ray. Both methods are often followed by prolonged immobilization to prevent gapping after suture repair and nonunion after transposition, respectively. We propose the use of an intramedullary nail for metacarpal fixation after ray transposition. This provides the advantage of early mobilization, potentially reducing stiffness and hardware irritation, thus enabling an early return to work.