Operative Technique

A, A 3- to 4-cm longitudinal incision is made over the dorsal aspect of the proximal interphalangeal (PIP) joint parallel to and at the lateral border of the extensor digitorum longus tendon. The subcutaneous tissue is divided and the skin flaps are retracted.

B, The long extensor tendon is split and retracted to expose the capsule of the PIP joint. The digital vessels and nerves are protected from injury. A transverse incision is made in the capsule, and the joint surfaces are widely exposed.

C and D, With a rongeur, wedges of bone based dorsally are resected from the head of the proximal phalanx and the base of the middle phalanx. Enough bone should be removed to allow correction of the deformity.

E and F, The proximal and middle phalanges are held together by internal fixation with a Kirschner wire that is inserted retrogradely. The Kirschner wire should not cross the metatarsophalangeal joint. The cancellous bony surfaces of the middle and proximal phalanges should be apposed, and the rotational alignment should be correct. The capsule is resutured tightly by reefing. The wound is closed in a routine manner. The end of the Kirschner wire is bent 90 degrees and cut, with 0.5 cm of wire left protruding through the skin.