Kirschner Wires and Bone Allograft Salvage Finger Motion in Pathologic Fracture of Middle Phalanx Enchondroma: A Case Report.

INTRODUCTION: Pathologic phalangeal fracture is a common initial presentation of solitary enchondroma of the finger. Enchondromas of the middle phalanx are most frequently associated with post-operative range of motion deficits. This report describes a case in which the use of Kirschner wires (K-wires) and allograft bone were used to salvage finger motion following surgical fixation of pathologic fracture of a middle phalanx enchondroma with extensor tendon injury.

CASE REPORT: A 37-year-old right hand dominant woman presents with pathologic fracture of the left index finger middle phalanx. The patient elected for surgical intervention to stabilize fracture and enable early motion at the proximal interphalangeal joint (PIP). Surgical fixation involved tumor curettage, fracture stabilization and length preservation with longitudinal K-wires, allograft bone with hardening properties to fill the bony defect, and dorsal K-wires for securing the extensor tendon. At follow-up 11 months postoperatively, the allograft had almost completely resolved, and the patient had regained PIP flexion of 90° and full extension.

CONCLUSION: Pathologic fracture of middle phalanx enchondroma is prone to complication by extensor tendon injury and associated post-operative loss of motion. Bone grafting and Kirschner wire fixation allowed for early mobilization of finger motion and thus may be a useful technique for use in treatment of other pathologic fractures.