Intramedullary Strut Bone Peg Technique for Revision of Metacarpal and Phalangeal Nonunion After Failed Plate Fixation

Metacarpal and phalangeal nonunion is rare; however, surgery is required if these fractures result in instability or persistent pain. Revision of nonunion following plate fixation is challenging, as it demands bone grafting at the nonunion site and stable fixation. Here, we present a surgical technique for managing metacarpal and phalangeal nonunion after failed plate fixation using an intramedullary strut bone peg reinforced with intramedullary K-wires. This technique achieves a high union rate by increasing the intramedullary contact surface, promoting bone healing. Moreover, intramedullary K-wires bypass previous screw holes and help maintain fracture apposition and alignment at the nonunion sites.