PMC9198418_01
(a) Dorsal plane view of the pre-operative flail deformity with an abnormal digital parabola. (b) Sagittal plane view of the pre-operative flail deformity. (c) Pre-operative radiograph demonstrating flail fourth digit and biphalangic fifth digit.
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On clinical examination, the foot displayed abnormal digital parabola with a short fourth digit that was elevated at the metatarsophalangeal joint and hyperextended at the proximal interphalangeal joint (Figure 1(a) and (b)). A biphalangic fifth digit was evident (Figure 1(c)) and chosen as an autologous bone graft.
(a) Biphalangic graft harvesting from fifth digit. (b) Dorsal view of stabilised inter-locking graft using smooth Kirschner wire. (c) Postoperative 6 months X-ray with full graft consolidation. (d) Postoperative aligned fourth digit in ground contact and parabola achieved.
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A transverse linear incision was made over the apex of the fifth digit and deepened to bone and soft tissues reflected off the phalanx (Figures 2(a)). The graft was introduced and interlocked and stabilised with antegrade and retrograde technique using 1.4 mm Kirschner wire (Figures 2(b)). At 6 months review, the X-ray showed full bone consolidation, fine alignment, and length of the 4th digit was achieved (Figure 2(c)). When weight bearing, the digit maintained ground contact and alignment, and the patient was asymptomatic (Figures 2(d)).