Autologous Bone Peg Grafting for Distal Phalanx Nonunion: A Report of Two Cases

Distal phalangeal nonunion is a rare but challenging condition that may result from crush injuries or inadequate stabilization. Surgical fixation is often difficult because of the small size of the fragment and surrounding soft tissue damage. We report two cases of symptomatic distal phalanx nonunion successfully treated with autologous bone peg grafting. The first case involved a 13-year-old boy who developed nonunion following a bicycle injury. The second case involved a 31-year-old man who sustained an open fracture in a workplace accident. In both cases, a cortical bone peg harvested from the posterior aspect of the ipsilateral proximal ulna was inserted into the medullary canal of the distal phalanx to provide mechanical stability and promote bone healing. Radiographic union was achieved within 3 months, and both patients returned to full activity, with one experiencing minor residual symptoms.