Dear Sir, Unstable, comminuted intra-articular fractures of the base of the proximal phalanx (PP) are challenging injuries to treat. Closed treatment and casting often inadequately maintain proper alignment and impede wound care when there are open wounds, such as gunshot wounds. It is difficult to maintain the length and stability using Kirschner wires when the base of the PP is severely comminuted. Open reduction and internal fixation (ORIF) may not be feasible because of the extent of the comminution and the state of the soft tissues (Omokawa et al., 2008). We have been using a novel external distraction technique for the treatment of comminuted intra-articular fractures of the base of PP with satisfactory outcomes (Fig 1). Patients who have comminuted intra-articular fractures of the base of PP that are not amenable to percutaneous pinning or ORIF undergo distraction external fixation.
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机译：尊敬的主席先生：近端指骨（PP）底部的不稳定，粉碎性关节内骨折正在挑战治疗中。当存在开放性伤口（例如枪伤）时，封闭式治疗和石膏浇铸往往不足以保持适当的对准并妨碍伤口护理。当PP的底部严重粉碎时，使用Kirschner导线很难保持长度和稳定性。由于粉碎的程度和软组织的状态，切开复位内固定术（ORIF）可能不可行（Omokawa et al。，2008）。我们一直在使用一种新颖的外部牵引技术来治疗PP基底的粉碎性关节内骨折，并获得满意的结果（图1）。粉碎了不适合经皮钉扎或ORIF的PP基底的关节内骨折的患者，进行了分散性外固定。
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