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Abstract Background Arthrodesis serves as the traditional therapeutic approach for advanced distal interphalangeal joint (DIPJ) arthritis. However, the conventional technique may prove insufficient when the excision of pronounced volar and lateral spurs is required. To address this, we innovated the 'smile incision with reverse shotgun approach'. This method enhances joint exposure and yields superior cosmetic results by extending the transverse skin incision over the DIPJ and cleaving the accessory collateral ligament, thereby improving access to the volar and lateral joint margins. This article meticulously elucidates the surgical procedure and presents preliminary results of its implementation. Method The clinical data of 22 consecutive patients (36 fingers) who received DIPJ arthrodesis by this procedure during March 2018 to October 2022, with a mean follow-up period of 9.8 months, were reviewed. Patients’ demographics, union rate, complications, radiographic findings, as well as visual analogue scale (VAS) for pain and satisfaction, were collected and analyzed. Results Thirty-five of 36 fingers achieved uneventful bony union (97.2%). The average VAS for pain and satisfaction as well as he coronal plane deviation of DIPJ significantly improved after the operation (all, P