From the Guidelines
A displaced fracture of the proximal phalanx of the pinky toe can often be managed with simple immobilization when fracture fragments are small, nonarticular, or minimally displaced, as indicated by the American College of Foot and Ankle Surgeons 1. When managing a proximal phalanx displaced fracture of the pinky toe, it's essential to consider the size and displacement of the fracture fragments.
- For small, nonarticular, or minimally displaced fractures, immobilization is typically sufficient, allowing the fracture to heal without surgical intervention.
- The immobilization can be achieved through buddy-taping the injured toe to the adjacent fourth toe, using medical tape with gauze between the toes to prevent skin irritation, and changing the taping every 1-2 days for 3-4 weeks.
- Additionally, applying the RICE principle (rest, ice, compression, and elevation) can help reduce pain and swelling, with ice applied for 15-20 minutes several times daily for the first 48-72 hours.
- Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can be used for pain relief.
- It's crucial to wear wide, comfortable shoes that don't put pressure on the toe and allow weight-bearing as tolerated with a stiff-soled shoe or walking boot for comfort.
- Most pinky toe fractures heal within 4-6 weeks without surgical intervention, but if pain is severe or the displacement is significant (more than 2mm or with rotation), consultation with an orthopedic specialist is necessary to determine if reduction or surgical fixation might be necessary, as suggested by the principles outlined in the American Family Physician journal 1.
From the Research
Treatment Options for Proximal Phalanx Displaced Fracture of Pinky Toe
- The treatment for proximal phalanx displaced fracture of the pinky toe can vary depending on the severity and location of the fracture, as well as the patient's overall health and activity level 2, 3.
- Non-surgical management is often preferred for stable, extra-articular fractures of the proximal phalanx, and can include the use of a splint or cast to immobilize the toe and allow for healing 3, 4.
- For more severe or unstable fractures, surgical intervention may be necessary, such as open reduction with internal fixation using plate fixation or percutaneous headless compression screws 3, 5.
- The use of a custom-molded splint system, such as the one described in 2, can allow for protected mobilization and early range of motion, which can help to promote healing and reduce the risk of stiffness and other complications.
Outcomes and Complications
- Studies have shown that patients with proximal phalanx fractures can experience a range of outcomes, including full recovery of motion and function, as well as complications such as stiffness, infection, and malunion 5, 6.
- The type and severity of the fracture, as well as the treatment approach used, can influence the likelihood of complications and the overall outcome for the patient 6.
- In some cases, patients may experience minor deformity or coronal plane deviation, but this may not necessarily affect their overall function or satisfaction with the outcome 6, 4.
Specific Considerations for Pediatric Patients
- Pediatric patients with displaced proximal phalanx fractures may be at higher risk for complications such as stiffness and malunion, particularly if they have subcondylar fractures 6.
- However, studies have shown that with proper treatment, including closed reduction and percutaneous pinning, pediatric patients can achieve full motion and function, with minimal pain and deformity 6.