Nonunion in a fracture of the proximal phalanx of the thumb

We describe the management of atrophic nonunion in a fracture of the proxim al phalanx of the thumb in a patient who presented one and a half years aft er the injury. By using threaded external fixators applied across the fract ure nonunion, stability for active mobilization of the metacarpophalangeal joint was achieved. The gradual distraction resulted in correction of the d eformity and the shortening, as well as creation of an adequate space betwe en the bone ends. Bone grafting and compression of the fracture with the sa me fixators followed. Consolidation of the fracture occurred within five mo nths. Follow-up examination two and a half years postoperatively revealed c omplete remodeling of the fracture and excellent function of the hand.