Hybrid Intramedullary and Extra-Articular K-Wire Fixation for Proximal Phalanx Base Fractures: A Prospective Pilot Study

Introduction: Extra-articular base fractures of the proximal phalanx remain a surgical challenge due to their tendency toward rotational deformity and post-operative stiffness. Conventional fixation methods, such as trans-articular and cross-pinning, offer satisfactory stability but often compromise joint mobility. To address these limitations, a novel hybrid intramedullary–extra-articular Kirschner wire (K-wire) fixation technique was developed, aimed at improving rotational stability while preserving early motion and minimizing soft-tissue disruption. Materials and Methods: This prospective study included 15 patients with closed, unstable base fractures of the proximal phalanx treated between January 2023 and June 2025. This was designed as a pilot feasibility study. The technique involved the intramedullary insertion of a dorsolateral K-wire, supplemented by a convergent dorsomedial extra-articular pin, to enhance rotational stability. Early active and passive mobilization was initiated on the first postoperative day. Functional outcomes were assessed using Belsky’s criteria and total active motion (TAM) at 6 weeks, 3 months, and 6 months. Results: The mean age of the cohort was 37.1 ± 15.1 years, with 60% of the participants being male. The predominant mechanism of injury was a motor vehicle accident (66.7%). The mean proximal interphalangeal joint motion was 100.3° ± 9.0°, and the mean TAM was 211.3° ± 12.2°, with 73.3% of patients rated as excellent and 20% as good as per Belsky’s criteria. No cases of infection, nonunion, or loss of reduction were observed. Conclusion: The hybrid intramedullary–extra-articular K-wire fixation technique appears to provide stable fixation with favorable functional outcomes, though larger comparative studies are required to validate these findings. It facilitates early mobilization, preserves joint function, and reduces stiffness compared with conventional fixation methods, making it a promising alternative in both high-volume and resource-limited settings.