From the Guidelines
Treatment for a Salter-Harris type 2 fracture of the proximal phalanx of the right little toe in a 6-year-old typically involves conservative management with immobilization. The recommended approach is immobilization with buddy taping to the adjacent fourth toe using soft padding between the toes and medical tape for 3-4 weeks, as simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1. Weight-bearing is usually allowed as tolerated, with a rigid-soled or post-operative shoe to protect the toe during healing. Pain management can include acetaminophen (10-15 mg/kg every 4-6 hours as needed) or ibuprofen (5-10 mg/kg every 6-8 hours with food) for the first few days. Some key considerations for treatment include:
- Ice application for 15-20 minutes several times daily
- Elevation of the foot when sitting or lying down to reduce swelling
- Follow-up at 3-4 weeks to ensure proper healing, though complete radiographic healing may take 6-8 weeks
- Orthopedic consultation may be necessary if the fracture is significantly displaced (>2mm) or angulated (>10 degrees), though this is uncommon for little toe fractures. Most pediatric toe fractures heal well with minimal intervention due to children's excellent healing capacity and the remodeling potential of growing bones.
From the Research
Treatment Options for Salter Harris Type 2 Fracture
- The treatment for Salter Harris type 2 fracture of the proximal phalanx of the little toe in a 6-year-old can be managed conservatively with splintage or immobilization 2, 3, 4.
- Nondisplaced or stable fractures can be managed with splint immobilization, while unstable or displaced fractures may require surgical management, preferably via closed reduction and percutaneous pinning 5.
- Buddy taping can also be considered as a treatment option for Salter-Harris II fractures of the proximal phalanx, with studies showing high rates of patient comfort and satisfaction, and low rates of secondary displacement 6.
Key Considerations
- A thorough physical examination is necessary to assess for signs of rotational deformity and/or coronal malalignment 5.
- Plain radiographs of the foot and toes are sufficient to confirm a diagnosis of a phalangeal fracture 5, 4.
- The management of phalangeal fractures depends on the initial severity of the injury and the success of closed reduction techniques 5.