Abstract
Dear Sir,
We read this paper with interest and thank the authors for reporting their experience in the surgical treatment of nonunion of fractures of the distal phalanx. Özçelik et al. recommend surgical treatment with bone graft harvested from the olecranon and stabilization of the nonunion with a Kirschner wire. We too, found that nonunion of these fractures are mostly atrophic and agree that surgery is needed, but only for symptomatic nonunion and possibly within the first three months after trauma.
Our preferred treatment of atrophic nonunions is cancellous bone grafting after excision of the fibrous tissue (Voche et al., 1995) but we prefer obtaining the graft from the distal radius Lister tubercle as it does not create esthetical problems because the 3 cm long scar is barely visible, moreover, in men, it will be covered by hair. This technique avoids a scar on a pressure area. As reported by Itoh et al. (1985), we find that stabilization with Kirschner wires is sufficient. We believe that a central longitudinal exposure of the proximal part of the distal phalanx is a safer exposure (Itoh et al., 1985) than the lateral one proposed by Özçelik et al., allows an easier realignment of the fragments, and avoids loss of sensation especially if the incision does not extend into the distal part, where the majority of mechanoreceptors are located (Johansson et al., 1979). In our experience union is usually achieved about 8 weeks after the surgical procedure.