From the Guidelines
The patient with a nondisplaced Salter-Harris type III fracture of the distal phalanx of the third digit at the DIP joint should be treated with simple immobilization, as the fracture fragments are minimally displaced and nonarticular. The X-ray of the right toe taken on 5/15/25 shows a nondisplaced Salter-Harris type III fracture of the distal phalanx of the third digit at the DIP (distal interphalangeal) joint. This fracture has not changed in alignment since previous imaging. A Salter-Harris III fracture involves the growth plate and extends into the joint surface.
- Key aspects of treatment include:
- Immobilization with a rigid toe splint for 3-4 weeks
- Elevation of the foot when possible
- Weight-bearing as tolerated with a post-operative shoe or hard-soled shoe to protect the toe
- Pain management with acetaminophen 650mg every 6 hours or ibuprofen 400mg every 8 hours as needed
- Ice the area for 15-20 minutes several times daily to reduce swelling According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician 1, simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. Since the fracture is nondisplaced, surgical intervention is not necessary, but follow-up imaging in 2-3 weeks is recommended to ensure proper healing. If pain worsens, swelling increases, or you notice any change in toe alignment, seek immediate medical attention.
From the Research
Fracture Type and Location
- The patient has a Salter Harris III fracture dorsally of the third digit distal phalanx at the DIP joint, which is a type of fracture that involves the epiphyseal plate and the joint surface 2.
- This type of fracture is rare and can be difficult to diagnose, especially in the distal phalanges of the toes 2.
Treatment and Management
- The treatment for Salter Harris III fractures typically involves anatomical reduction and stabilization to prevent complications such as physeal arrest and growth disturbances 3, 4.
- In some cases, surgical treatment may be necessary to achieve anatomical reduction and stability, especially if the fracture is displaced or if there is a risk of growth disturbance 3, 5.
- The goal of treatment is to achieve anatomical alignment and stability, and to prevent complications such as physeal arrest, growth disturbances, and osteoarthritis 3, 4.
Prognosis and Outcomes
- The prognosis for Salter Harris III fractures is generally good if treated promptly and appropriately, with most patients achieving good functional and radiological outcomes 3, 4.
- However, delayed diagnosis and treatment can lead to significant morbidity, including prolonged casting and possible surgical treatment 4.
- The patient's outcome will depend on various factors, including the severity of the fracture, the effectiveness of treatment, and the patient's overall health and activity level 3, 4.