title: Extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx.
abstract: OBJECTIVE
  To evaluate an extra-articular osteotomy rather than an intra-articular osteotomy in the treatment of malunited unicondylar fractures of the proximal phalanx.
  
  
  METHODS
  An extra-articular osteotomy was used to correct the deformity resulting from a malunion of a unicondylar fracture of the proximal phalanx in 5 patients. A closing wedge osteotomy that was stabilized with tension band fixation accomplished realignment of the joint. Each patient was evaluated at a minimum of 1 year after surgery for radiographic healing, correction of angulation, digital motion, postoperative complications, current level of pain with motion, and overall satisfaction with the procedure.
  
  
  RESULTS
  All of the osteotomies healed by 10 to 12 weeks after surgery with an average angular correction from 25 degrees to 1 degrees . The average proximal interphalangeal joint motion improved to 86 degrees from the preoperative average of 40 degrees , whereas the average total digital motion improved from 154 degrees before surgery to 204 degrees at follow-up evaluation.
  
  
  CONCLUSIONS
  This method of extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx is highly reproducible, avoids the risks of intra-articular surgery, and leads to a predictable outcome.
authors.affiliation: Harvard Medical School, Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Harness
authors.forename: Alvin
authors.initials: A
authors.lastname: Chen
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
mesh_terms: D000293:Adolescent; D000328:Adult; D001864:Bone Wires; D005260:Female; D005383:Finger Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013165:Splints; D016896:Treatment Outcome