Emergency Fixation of an Open Distal Phalanx Fracture Using an 18-Gauge Hypodermic Needle: A Case Report

Open distal phalanx fractures with nail-bed injury require prompt treatment of both the fracture and the nail-unit soft tissues. Kirschner-wire fixation is commonly used when an unstable fracture requires stabilization, but operating-room access and fluoroscopy may be delayed or unavailable in high-volume or resource-constrained emergency settings. Published series suggest that hypodermic-needle fixation can be an alternative in selected distal phalanx fractures, although the evidence remains limited. A 49-year-old man with hearing impairment sustained a door-crush injury to the dominant left middle finger, producing an open distal phalanx fracture with nail-bed laceration. Because timely operating-room access was not available, definitive management of the open injury was performed in the emergency department, with temporary fracture stabilization using a hypodermic needle. Under local anesthesia and sterile conditions, the open injury was irrigated and debrided, nail trephination and nail-bed repair were performed, and the fracture was reduced and stabilized with a sterile 18-gauge (38-mm) hypodermic needle. The wound was closed primarily, a finger splint was applied, tetanus prophylaxis was administered, and oral amoxicillin-clavulanate was prescribed for seven days. Immediate radiographs confirmed acceptable alignment. The needle was removed at four weeks, followed by gentle range-of-motion exercises. At six weeks, alignment and soft-tissue healing were maintained, fingertip sensibility remained intact, distal interphalangeal motion had returned, and no infection, fixation failure, or secondary operation was required. This case demonstrates the feasibility of hypodermic-needle fixation as a resource-contingent option in a carefully selected open distal phalanx fracture when conventional operative resources are not immediately available. This approach should not be interpreted as a substitute for standard operative fixation when formal surgical management is indicated.