Does a non-union fracture of the proximal phalanx of the left thumb indicate a need for bone grafting?

From the Guidelines

Bone grafting is not immediately indicated for a non-union fracture of the proximal phalanx of the left thumb, and instead, surgery with immobilization should be considered first. The decision to proceed with bone grafting depends on several factors, including the duration of the non-union, the patient's symptoms, functional limitations, and the specific characteristics of the non-union site. According to 1, the diagnosis of such fractures is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies, and surgery is the usual treatment, with simple immobilization being appropriate when fracture fragments are small, nonarticular, or minimally displaced.

Key Considerations

• The patient's symptoms and functional limitations play a significant role in deciding the treatment approach
• Immobilization with a cast or splint for 6-8 weeks is typically the first line of treatment
• Bone stimulation devices may be used in conjunction with immobilization to promote healing
• Surgical intervention, including internal fixation and bone grafting, is considered if conservative treatments fail
• Autologous bone graft is preferred due to its osteogenic properties, which enhance new bone formation

Treatment Approach

• Initial treatment should focus on immobilization and possibly bone stimulation
• If this approach fails, surgical options, including bone grafting, should be considered
• The choice of surgical technique and the decision to use bone grafting should be based on the individual patient's condition and the characteristics of the non-union fracture, as suggested by 1
• Recovery after any surgical intervention requires careful management, including protected motion for 6-12 weeks followed by physical therapy to restore thumb function.

From the Research

Non-Union Fracture of Proximal Phalanx of Left Thumb

• The management of non-union fractures of the proximal phalanx of the thumb may involve bone grafting, as seen in studies 2, 3, 4.
• A study from 2000 2 describes the use of threaded external fixators and bone grafting to achieve consolidation of a non-union fracture of the proximal phalanx of the thumb.
• Another study from 2021 3 reports the use of open reduction, tibial strut bone grafting, and internal fixation to manage a delayed presentation of post-traumatic gap non-union of the proximal phalanx of the thumb in a child.
• However, not all non-union fractures of the proximal phalanx require bone grafting, as some may be managed with non-operative treatment or other surgical methods, such as the use of facial plates 4 or screws and Kirschner wires 5.
• A study from 2003 6 suggests that non-operative treatment may be recommended for displaced or rotated avulsion fractures of the ulnar base of the proximal phalanx of the thumb, provided that there is no lateral instability of the metacarpophalangeal joint.

Indications for Bone Grafting

• Bone grafting may be indicated in cases of non-union fractures with a segmental gap or significant bone loss, as seen in studies 2, 3.
• The use of bone grafting in non-union fractures of the proximal phalanx of the thumb may depend on the specific characteristics of the fracture and the patient's overall condition.
• Further evaluation and consideration of individual patient factors are necessary to determine the most appropriate treatment approach for a non-union fracture of the proximal phalanx of the left thumb.