Minimally invasive management of a comminuted bicondylar middle phalanx head fracture using Joshi’s external stabilization system: a case report

Fractures of the middle phalanx head are uncommon injuries that pose a challenge in restoring articular congruity while preserving proximal interphalangeal (PIP) joint mobility and extensor tendon function. We report the case of a right-hand-dominant 29-year-old male software engineer who sustained a closed, comminuted bicondylar intra-articular fracture of the right little finger middle phalanx following a road traffic accident. Three days after injury, closed reduction under fluoroscopic guidance and percutaneous fixation using a modified Joshi’s External Stabilization System (JESS) was performed under regional anaesthesia. The construct comprised two 2.0-mm and two 1.6-mm Kirschner wires, four mini-clamps, and two connecting rods. The procedure lasted 30 minutes. The fixator was maintained for four weeks, followed by supervised rehabilitation. Radiographs at four weeks confirmed fracture union, maintained articular congruity, and no loss of reduction. At final follow-up, the patient achieved a total active motion of 220°, with MCP, PIP, and DIP joint arcs of 90°, 100°, and 30°, respectively. Grip strength recovered to 95% of the contralateral hand, and pain was minimal (VAS 1/10). The patient returned to full occupational computer work at four weeks, without pin-tract infection, joint stiffness, malunion, or hardware-related complications. This case highlights modified JESS fixation as a minimally invasive option for selected comminuted intra-articular fractures of the middle phalanx head. It may facilitate maintenance of reduction while preserving tendon gliding and supporting functional recovery through timely rehabilitation.