Combined Intramedullary-External K-Wire Fixation for Phalangeal Fractures: Description of a Surgical Technique

Although early mobilization is essential for functional recovery after phalangeal fractures, many fixation methods still require prolonged immobilization, increasing the risk of joint stiffness. We herein describe a simple, safe, and low-cost technique that combines intramedullary Kirschner wires (K-wires) with external connection, adapted from the Ulson method, which was originally developed for distal radius fractures. The procedure consists of closed reduction under fluoroscopy followed by the insertion of two 1.0-mm intramedullary wires. The external ends of these wires are bent and connected, forming a stable frame that enables immediate mobilization without the need for immobilization. The technique provided stable fixation, reliable bone healing, and early rehabilitation, with a low complication rate. It represents a practical and reproducible option, especially useful in resource-limited settings.