Hypodermic Needle Osteosynthesis: A Pragmatic Solution for Manual Workers and Vulnerable Populations in Resource-Constrained Settings

Abstract

Background: Fingertip injuries, particularly unstable distal phalanx fractures and open mallet-type extensor tendon injuries, impose a significant socioeconomic burden, especially on working-age adults in precarious employment. While internal fixation is often required to preserve alignment and function, the gold standard—Kirschner wire (K-wire) fixation under fluoroscopic guidance—is frequently inaccessible in emergency settings or for patients with limited financial resources. 

Methods: We present two patients presenting to the emergency department with unstable distal phalanx injuries. In the absence of intraoperative fluoroscopy and orthopedic power drills, stabilization was achieved using standard sterile hypodermic needles (18–21 gauge) as intramedullary or transarticular fixation devices. 

Results: Successful immediate stabilization was achieved in both cases. The needle fixation technique effectively reduced fracture displacement and, in the tendon injury case, restored the continuity of the extensor mechanism. At the final follow-up, all patients demonstrated maintained alignment and clinical fracture union. Functional outcomes were favorable, with patients regaining a pain-free range of motion at the distal interphalangeal joint and returning to daily manual labor without significant delay.

Conclusion: Hypodermic needle osteosynthesis is a safe, accessible, and highly cost-effective technique for damage-control fixation of selected fingertip injuries.