A Case of Bone Nonunion in the Middle Phalanx Treated with Cancellous Bone Grafting Using a Linked-Wire Type of External Fixator (Ichi-Fixator System)

We herein report successful cancellous bone grafting with minimally invasive surgery using a linked wire-type external fixator (Ichi-Fixator System). A 40-year-old woman presented with an open comminuted fracture of the middle phalanx of the right index finger. The patient had undergone multiple surgeries, including an iliac strut bone graft, by a previous physician; however, nonunion occurred at the index phalanx. We observed that the soft tissue distal to the non-union site was atrophic. This indicated that the tissue surrounding the nonunion site developed circulatory disturbances as a result of previous surgeries. We applied the Ichi-Fixator System as an external wound fixator and performed cancellous bone grafting at the nonunion site. The fixator pins of the Ichi-Fixator System fell off unexpectedly six weeks postoperatively. An extension splint on the palmar side of the index finger was used continuously to immobilize the finger for two months postoperatively. Osteogenesis progressed, and the area of nonunion was completely ossified six months postoperatively. The minimally invasive surgery in this case was considered to have led to good results.