Modified Distraction Lengthening Via a Cross-Nail Bed Approach for Aesthetic Reconstruction of Traumatic Fingertip Defects

Objective: To report the clinical effect of distraction lengthening through a cross-nail bed incision for the correction of traumatic nail deformity. Methods: A retrospective case series of patients with traumatic short nail deformity who underwent distraction lengthening of the distal phalanx from March 2020 to March 2025 was conducted. A transverse osteotomy was made at the mid-portion of the residual distal phalanx. One screw was inserted on both the distal and proximal sides of the osteotomy line, followed by placement of a mini external fixator. Gradual distraction was performed postoperatively until the desired length was achieved. Surgical outcomes were evaluated using morphologic measurements and patient satisfaction. Results: A total of 28 patients (5 males, 23 females; mean age 35 y) were included. The affected digits included the thumb (6 cases), middle finger (15), index finger (5), and ring finger (2). Mean distraction duration was 22 days, and mean external fixation time was 80 days. Mean follow-up was 15 months. Averaged nail length increased from 8.5to 11.6 mm while nail width decreased from 13.0 to 10.5 mm. Distal phalanx length on X-ray increased from 10.6 to 16.9 mm. Finger distal length increased from 18.9 to 23.5 mm. No significant impairment of interphalangeal joint mobility was observed. Patient satisfaction rate was 82.1% (23/28). Conclusion: Distraction lengthening through a cross-nail bed incision effectively corrects traumatic short nail deformity with satisfactory aesthetic outcomes.