A retrospective case series of the Park-Heo technique for surgical fixation of distal phalanx base fractures

Distal phalanx base fractures are difficult to manage because of strong tendon traction forces and the fragility of small bone fragments. Conventional fixation methods, such as Kirschner wires or pull-out sutures, may risk complications including skin necrosis and nail deformities due to dorsal incisions. To address these challenges, we applied a minimally invasive dorsal 2-point subcutaneous suture penetration technique, with the option of using a custom-made "M" endo-button to provide additional stability in complex cases. We conducted a retrospective review of patients with distal phalanx base fractures treated using a dorsal 2-point subcutaneous suture penetration technique, with or without a custom-made "M" endo-button. Patients were eligible if they had unstable or comminuted fractures requiring surgical fixation and were followed for at least 6 months. Radiographic union was assessed by 2 independent surgeons, and complications including skin necrosis, nail deformity, infection, and nonunion were systematically evaluated. Twelve patients (7 men, 5 women; mean age 41.6 years, range 26-65) were treated using this technique. Fracture types included comminuted (n = 8), combined dorsal and volar base fractures (n = 2), bony mallet fracture (n = 1), and flexor digitorum profundus avulsion with enchondroma (n = 1). Mean follow-up was 6.8 months, and mean time to bony union was 7.3 ± 3.9 weeks. Bone union was achieved in all cases, with no skin necrosis, nail deformities, or infections reported. Functional recovery was satisfactory, with preserved articular surface alignment. This case series suggests that the dorsal 2-point subcutaneous suture technique, with selective use of an "M" endo-button, can achieve bone union while avoiding major wound complications. These findings should be interpreted cautiously given the small sample size, retrospective design, and absence of a control group.