Surgical technique for collateral ligament avulsion fractures of the proximal interphalangeal joint with a rotated bony fragment

Collateral ligament avulsion fractures of the proximal interphalangeal (PIP) joint, particularly those with a rotated bony fragment, can lead to chronic instability and functional impairment. While many avulsion fractures can be managed conservatively, a subset with significant displacement and fragment rotation requires surgical intervention. This technical note describes a surgical technique using Kirschner wire fixation for managing displaced collateral ligament avulsion fractures with a rotated bony fragment involving the volar plate of the PIP joint. The technique is illustrated through a detailed case presentation and further supported by a brief discussion of four additional cases with similar injury patterns and successful outcomes.