[Results of the Intramedullary Elevation Technique for Unstable Middle Phalanx Base Impression Fractures]

Impression fractures of the base of the middle phalanx represent a therapeutic challenge due to central joint incongruity and a tendency towards dorsal subluxation. This study aimed to present the clinical and radiological outcomes of a larger patient cohort treated using the intramedullary tamping technique described by Hintringer and Ender.

A retrospective analysis of 92 patients (2012-2024) with unstable fractures of the base of the middle phalanx base was performed. Reduction was achieved percutaneously using a pre-bent intramedullary Kirschner wire, followed by retention with additional wires. Clinical and radiological endpoints, functional outcomes according to the classification of the American Society for Surgery of the Hand (ASSH), as well as complications were recorded.

Median impression depth was reduced from a median of 2.6 mm (0.6-5.5 mm) preoperatively to 0.7 mm (0-2.9 mm) postoperatively. The median total range of motion (ROM) was 210° (90°-335°). Outcome was excellent in 19 patients, good in 37 patients, fair in 32 patients, and poor in 4 patients based on the criteria of the American Society for Surgery of the Hand (ASSH). Patient age had a significant influence on ROM, whereas fracture type, timing of surgery, and residual impression did not reach statistical significance. Median operative time was 18 minutes. Three clinically relevant complications occurred.

The intramedullary tamping technique according to Hintringer and Ender is a safe, time-efficient and cost-effective treatment option with low complication rates and good functional outcomes. It allows direct reduction of centrally impacted fragments and remains feasible even in cases of delayed presentation.