Crossing screw fixation in first proximal phalanx fracture nonunion: A case report

Pedal phalangeal fractures are common, however, literature is lacking concerning reported treatment options for a hallux proximal phalanx nonunion. This case of a first proximal phalanx nonunion initially presented to the clinic following a traumatic injury and emergency room visit with radiographic analysis revealing a closed, mildly displaced first proximal phalanx fracture. After initial conservative treatment failed, the painful nonunion was treated operatively with open reduction and internal fixation. This report highlights the use of crossing screws as a method of surgical fixation with adjunctive use of bone allograft and bone stimulator, with immediate protected weightbearing included as part of the post-operative protocol. At 3 months following surgery, radiographic union was noted and the patient reported complete relief of pain. This supports utilizing the reported fixation method and weightbearing protocol, hopefully adding to the armamentarium available to practitioners when treating similar fractures and nonunions.