From the Guidelines
Treatment of proximal phalanx fractures should prioritize conservative management with buddy taping or closed reduction and splinting for stable and minimally displaced fractures, reserving surgical intervention for more complex cases with significant displacement, rotation, or angulation. When considering treatment options, it's essential to evaluate the fracture's characteristics, such as stability, displacement, and angulation.
- For stable, non-displaced fractures, conservative management with buddy taping to an adjacent finger for 3-4 weeks is typically sufficient, as it allows for proper healing while maintaining finger mobility.
- For minimally displaced fractures, closed reduction followed by splinting in the "safe position" (70-90° flexion at the MCP joint and slight flexion at the PIP joint) for 3-4 weeks is recommended, as this method helps to maintain fracture alignment and promote healing.
- More complex fractures with significant displacement, rotation, or angulation may require surgical intervention with Kirschner wires, screws, or plates, as seen in other types of fractures, such as distal radius fractures, where surgical fixation is suggested for fractures with postreduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement 1. However, it's crucial to note that the provided study 1 focuses on distal radius fractures, and its direct application to proximal phalanx fractures may be limited.
- Post-treatment, early protected motion is crucial to prevent stiffness, typically beginning 3-4 weeks after injury, and physical therapy focusing on range of motion exercises helps restore function.
- Patients should be monitored for complications such as malunion, nonunion, stiffness, or rotational deformity, and pain management typically involves acetaminophen or NSAIDs like ibuprofen 400-600mg every 6 hours as needed.
From the Research
Treatment Options for Proximal Phalanx Fractures
- Nonoperative treatment can be successful for stable fractures, with the goal of achieving fracture healing and maintaining gliding motion of the extensor and flexor tendons 2
- Unstable injuries may benefit from surgery, with the overriding goal of restoring anatomy and imparting enough stability to allow for early motion 2
- Dynamic treatment, including protected mobilization programs and custom-molded splints, can be used for nonoperative treatment or after operative treatment, allowing for bone healing and recovery of motion simultaneously 3, 4
Use of Splints and Orthoses
- Custom-molded splints can be used to allow motion of the proximal and distal interphalangeal joints, promoting bone healing and recovery of full active motion 3
- Removable orthoses can immobilize only the affected fingers, providing sufficient stability while maintaining mobility in other fingers and minimizing restrictions on fine motor movements 5
- Dynamic splinting techniques and fiberglass casting material can be used for nonsurgical treatment of pediatric fractures of the proximal phalanx, resulting in good functional results and almost free range of finger motion 6
Outcomes and Results
- Studies have shown that dynamic treatment of proximal phalanx fractures can result in high rates of fracture consolidation and recovery of full active motion, with minimal complications 3, 4
- Nonsurgical treatment of pediatric fractures of the proximal phalanx using dynamic splinting techniques can result in good functional results and minimal pain perception under active finger motion 6
- The use of orthoses in the conservative treatment of proximal phalanx fractures can provide sufficient stability while maintaining mobility and fine motor skills, with potential benefits for hygiene and patient comfort 5