From the Guidelines
Surgery is the usual treatment for proximal great toe phalanx fractures, but simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. When considering treatment for a proximal great toe phalanx fracture, it's essential to evaluate the fracture's characteristics, such as displacement and articular involvement. According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician in 2002 1, the diagnosis of a proximal great toe phalanx fracture is based on a history of trauma, focal pain on palpation, and confirmation with radiographic studies. Key considerations for treatment include:
- The size and displacement of the fracture fragments
- The articular involvement of the fracture
- The patient's overall health and activity level In general, non-displaced or minimally displaced fractures may be treated with simple immobilization, while displaced fractures may require surgical intervention to ensure proper alignment and healing. The goal of treatment is to restore function, prevent long-term complications, and improve quality of life by minimizing morbidity and mortality associated with the fracture. Treatment should be individualized based on the specific characteristics of the fracture and the patient's needs, with the primary aim of achieving optimal outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Treatment Options for Proximal Great Toe Phalanx Fracture
- Conservative management with buddy strapping or splintage is a common approach for proximal great toe phalanx fractures, especially for non-displaced or minimally displaced fractures 2, 3.
- Surgical management, such as open reduction and internal fixation with L-facial plates and screw, may be necessary for fractures that are displaced, intra-articular, or have failed conservative management 2, 4.
- Bone grafting may be required in some cases, especially for fractures with significant bone loss or non-union 2, 4.
Indications for Surgical Management
- Displaced intra-articular fractures of the proximal phalanx of the great toe 4, 5.
- Fractures with significant bone loss or non-union 2, 4.
- Fractures with underlying deformity, such as hallux valgus or claw toe 5.
- Delayed diagnosis or established non-union at presentation 5.
Outcomes and Return to Sport
- Conservative management can result in satisfactory outcomes, with return to sport rates ranging from 0 to 100% and return times ranging from 1.2 to 24 weeks 5.
- Surgical management can also result in satisfactory outcomes, with return to sport rates of 100% and return times ranging from 12 to 24 weeks 5.
- Early diagnosis and treatment are crucial to prevent complications and ensure optimal outcomes 4, 3.