From the Guidelines
To reset a 4th distal phalange fracture, closed reduction is typically performed under digital block anesthesia using 1-2% lidocaine without epinephrine, as this approach is supported by the most recent and highest quality study 1. The diagnosis of a 4th distal phalange fracture is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies, as noted in 1.
Key Considerations
- After adequate anesthesia, apply longitudinal traction to the finger while manipulating the fracture fragments back into anatomical alignment.
- For stable fractures, immobilize the finger with an aluminum splint or buddy taping to the adjacent finger for 3-4 weeks.
- For unstable fractures, Kirschner wire fixation may be necessary, which involves surgical placement of small wires to maintain alignment, as discussed in 1.
Post-Reduction Care
- Post-reduction, elevate the hand above heart level for 48 hours to minimize swelling.
- Prescribe appropriate analgesia such as acetaminophen 500-1000mg every 6 hours or ibuprofen 400-600mg every 6-8 hours for pain control, as suggested by general medical knowledge.
- Early range of motion exercises should begin after 2-3 weeks to prevent stiffness, but should avoid stress on the fracture site.
Follow-Up
- Follow-up radiographs at 1-2 weeks are recommended to ensure the fracture remains properly aligned during healing, as noted in 1 and 1. Proper reduction is crucial because malunion can lead to permanent deformity, pain, and decreased function of the finger. The approach to resetting a 4th distal phalange fracture should prioritize minimizing morbidity, mortality, and optimizing quality of life, and the approach outlined above is consistent with this goal, based on the evidence from 1.
From the Research
Treatment Options for 4th Distal Phalange Fracture
- The treatment of phalangeal fractures, including the 4th distal phalange fracture, depends on the characteristics of the fracture, condition of the soft tissue envelope, associated injuries, patient functional requirements, and surgeon familiarity and comfort with various techniques 2.
- Most phalangeal fractures can be treated successfully with nonoperative means, but surgery is considered to treat unstable injuries, articular incongruity, concomitant soft tissue damage, or other situations in which restoration of anatomy and preservation of function are achieved only via operative stabilization 2.
- For symptomatic nonunion of distal phalangeal fractures, open reduction and interfragmentary screw fixation can be an effective treatment modality with minimal morbidity 3.
Surgical Intervention
- Open reduction and internal fixation can be used to treat unstable phalangeal shaft fractures, including those of the 4th distal phalange, to provide rigid internal fixation and allow immediate range of motion and more rapid return to activity 4.
- The type of fixation method can range from percutaneous pinning to open reduction and internal fixation, and the choice of method depends on the specific fracture pattern and patient goals 5.
Non-Surgical Management
- Nonsurgical management is the preferred treatment of stable, extra-articular fractures of the proximal and middle phalanx, most distal phalanx fractures, and, rarely, nondisplaced intraarticular fractures 4.
- Closed reduction techniques can be used to manage commonly encountered phalangeal fracture patterns, and the choice of technique depends on the specific fracture pattern and patient goals 5.