Percutaneous Intramedullary Reduction of Impacted Fractures at the Base of the Middle Phalanx: Surgical Technique

Impacted fractures of the base of the middle phalanx frequently lead to joint incongruity and functional impairment. Although percutaneous intramedullary elevation of depressed articular fragments has been described previously, PRIME (Percutaneous-Pin, Reduce, Internal Fixation, Mobilize Early) represents a technical refinement that emphasizes true closed intramedullary disimpaction under local anesthesia, fully subcutaneous short-cut K-wire fixation, and a protocol of immediate active postoperative proximal interphalangeal (PIP) motion. It was applied in six consecutive patients with acute impacted base of the middle phalanx fractures involving the PIP joint. At final follow-up, patients demonstrated average PIP flexion of 90°, a mean visual analog scale pain score of 0.5, and a Disability of the Arm, Shoulder and Hand score of 1.3. Radiographs confirmed maintained reduction and union in all cases, with no major complications. The PRIME technique may provide a reproducible, minimally invasive method for restoring joint congruity and promoting early motion while reducing the risk of stiffness and soft tissue trauma. By integrating stable fixation and immediate rehabilitation, PRIME facilitates rapid recovery and excellent functional outcomes with minimal postoperative discomfort.