There are scenarios where the length of the digit cannot be preserved secondary to either significant trauma, or necrosis due to distal thrombosis of the digital arteries. Terminalization is warranted in these cases to provide a well-padded pain-free stump for the patient.
A fish-mouth incision is designed and the bone is cut back with rongeurs or an oscillating saw to allow for a tensionless closure. Important steps include burying and cauterizing the nerve stumps to prevent neuroma and avoiding the temptation of stitching the flexor and extensor tendons together over the bony stump (Fig. 18‑1, Fig. 18‑2, Fig. 18‑3, Fig. 18‑4, Fig. 18‑5, Fig. 18‑6, Fig. 18‑7, Fig. 18‑8, Fig. 18‑9).