Lesser toe malalignment can cause recurrent interdigital skin injury and limit footwear tolerance. We report the clinical course of a 53-year-old man with flexible medial deviation of the left fourth and fifth toes, recurrent pressure lesions, and shoe intolerance despite repeated lesion-directed treatment. Corrective proximal phalangeal osteotomies were performed using a standard orthopaedic drill and fluoroscopy when a dedicated percutaneous burr system was unavailable. A 1.0 mm guidewire was placed from dorsal to plantar, perpendicular to the toe long axis. In both toes, sequential 2.0, 2.7, 3.5, and 4.0 mm drilling was followed by controlled closure around a preserved medial hinge. Retrograde 1.5 mm Kirschner wires maintained correction without metatarsophalangeal joint transfixation and were removed on postoperative day 43. At postoperative day 46, the pressure-related hyperkeratotic lesion had resolved, the reported visual analogue scale pain score was 0, the patient reported tolerating conventional footwear, and alignment was maintained. Radiographs showed interval osseous healing without secondary displacement; no wound, pin-tract, or neurovascular complication was observed. This case documents short-term clinical improvement after an adaptation of available instruments. The brief follow-up and single-patient design preclude conclusions about mature union, durability, overall safety, or comparative effectiveness.

Background/Objectives: Inpatient falls are an important patient-safety concern in rehabilitation hospitals; however, factors determining whether a fall results in fracture remain poorly understood. This study investigated clinical factors associated with radiographically confirmed fracture after inpatient falls, evaluated the fracture-discrimination performance of the Morse Fall Scale and Hendrich II Fall Risk Model, and characterized the resulting orthopaedic burden. Methods: This single-center retrospective cohort study included adults who experienced a documented fall while hospitalized in a tertiary physical medicine and rehabilitation hospital. Patients with and without radiographically confirmed fractures were compared regarding demographic characteristics, comorbidity burden, bone health, continence, mobility, medication exposure, laboratory findings, and fall circumstances. Factors associated with fracture were evaluated using univariable analyses and a parsimonious Firth penalized logistic regression model. Discrimination of the Morse and Hendrich II scores was assessed using receiver operating characteristic analysis. Results: Among 91 adult inpatient fall events, 51 (56.0%) resulted in fracture. In unadjusted analyses, patients with fractures had lower lumbar spine T-scores and higher frequencies of urinary and fecal incontinence, whereas age, sex, femoral T-score, mobility status, fall location, and fall mechanism did not differ significantly between groups. In the adjusted Firth model comprising 87 complete cases and 49 fracture events, no variable reached independent statistical significance; lower lumbar T-score (adjusted odds ratio [aOR], 0.74; 95% confidence interval [CI], 0.52–1.05; p = 0.073) and urinary incontinence (aOR, 2.30; 95% CI, 0.87–6.12; p = 0.082) showed the strongest associations. The Morse and Hendrich II scores demonstrated poor fracture discrimination, with AUCs of 0.372 (95% CI, 0.255–0.489) and 0.411 (95% CI, 0.295–0.526), respectively, without a significant difference between them (p = 0.500). Among patients with fractures, 41.2% sustained major fractures, 27.5% underwent surgery, and 11.8% developed complications. Conclusions: Among documented inpatient falls in this rehabilitation cohort, fractures were common and imposed a clinically important orthopaedic burden. Conventional fall-risk scores did not distinguish falls resulting in fracture, suggesting that prediction of fall occurrence and prediction of orthopaedic injury represent distinct clinical objectives. Fracture-prevention strategies in rehabilitation settings should therefore complement general fall-risk assessment with targeted evaluation of skeletal and functional vulnerability.