Rotation at the site of fracture of a phalanx or metacarpal should be avoided during primary treatment by direct observation and appropriate splinting so that the fingers comfortably fit together in flexion.
Rotational malunion of both the proximal phalaux and the metacarpal when already present has been correctcd by rotational osteotomy at the base of the metacarpal.
With fixation by three Kirschner wires, no external fixation is required and prolonged external immobilization is avoided. All patients moved their fingers actively immediately after operation.
In two patients with malunion of fractures of the proximal phalanx, tendolysis of flexors in the fingers was performed at the same time as the osteotomy with excellent results.