Subcondylar Fossa Reconstruction in Pediatric Patients Following Malunion of Proximal Phalangeal Neck Fractures: Technique and Case Series

The subcondylar fossa is the bony depression between the articulating surface of the proximal and middle phalanges of the fingers that allows for full flexion at the proximal interphalangeal joint. A bony block may form in the subcondylar fossa secondary to the malunion of a proximal phalangeal neck fracture. If there is a substantial loss of flexion, surgical correction could be indicated. Corrective osteotomy is technically challenging in the proximal interphalangeal joint area as the phalangeal head is small, creating fixation challenges and carrying the risk of avascular necrosis and joint contracture. Current literature describes multiple techniques with varying complexity and there is no consensus on the ideal operation to manage these fractures after malunion. The subcondylar fossa reconstruction first proposed by Simmons and colleagues is a simple and safe surgical technique that involves directly removing the bony block at the phalangeal neck. Despite its utility, it has not been described in pediatric patients since its original report of 3 patients in 1987. This study describes the subcondylar fossa reconstruction technique and presents the outcomes of its application in 4 pediatric patients.