Modified Manktelow Step-Cut Osteotomy for Rotational Malunion of the Long Fingers: Tips and Pearls From a 7-Patient Series

BACKGROUND: Rotational malunion of the long fingers is poorly tolerated because even minor degrees of deformity may produce clinically relevant digital overlap, impaired grip, and aesthetic concerns. The modified Manktelow step-cut osteotomy is a reproducible technique that allows controlled derotation of metacarpal and proximal phalangeal malunions while preserving a broad cancellous contact surface for stable fixation and early mobilization. METHOD: This article describes the indications, surgical planning, technical steps, and practical pearls for performing this osteotomy. We also report our clinical experience in 7 patients treated for symptomatic rotational malunion of the long fingers. RESULTS: The mean preoperative rotational deformity was 20°. Complete correction was achieved in 5 patients, and the 2 remaining patients had improved but mild residual deformity. Mean total active motion improved postoperatively, and no complications, revision procedures, hardware failures, or nonunions were observed. Key technical points include careful preoperative assessment of digital overlap, intraoperative verification of derotation using the tenodesis effect, preservation of the volar cortex until controlled closure of the dorsal resection gap, and stable screw fixation with minimal hardware. CONCLUSION: The modified Manktelow step-cut osteotomy is a useful and reliable option for selected rotational malunions of the long fingers, particularly when accurate correction and early mobilization are desired.