From the Guidelines
Yes, refer to orthopedics for a mildly displaced distal phalanx fracture. For immediate management:
- Immobilize the affected finger with a splint
- Apply ice to reduce swelling
- Elevate the hand above heart level
- Prescribe pain medication (e.g., ibuprofen 400-600 mg every 6-8 hours as needed) Orthopedic referral is necessary because:
- Proper alignment is crucial for optimal healing and function
- Even mild displacement may require reduction or surgical intervention
- An orthopedic specialist can assess the need for more advanced imaging (e.g., CT scan)
- They can provide specialized follow-up care and rehabilitation guidance While waiting for the orthopedic appointment, advise the patient to:
- Avoid using the affected finger
- Keep the splint dry and clean
- Watch for signs of infection (increased pain, redness, swelling, fever)
- Return immediately if symptoms worsen Proper management is essential to prevent complications like malunion, stiffness, or chronic pain, which can significantly impact hand function, as highlighted in the American Academy of Orthopaedic Surgeons guidelines 1. Additionally, the American College of Radiology suggests that radiographs are usually sufficient for the evaluation of osseous injuries, but an orthopedic specialist can determine the need for more advanced imaging 1.
In terms of specific management, the American Academy of Orthopaedic Surgeons guidelines emphasize the importance of proper alignment and reduction for optimal healing and function 1. The guidelines also highlight the need for specialized follow-up care and rehabilitation guidance to prevent complications and promote optimal recovery.
It's worth noting that while some studies may suggest that simple immobilization is appropriate for small, nonarticular, or minimally displaced fractures 1, the most recent and highest quality evidence suggests that orthopedic referral is necessary for optimal management of mildly displaced distal phalanx fractures 1.
Overall, the priority should be to minimize morbidity, mortality, and improve quality of life, and orthopedic referral is the best course of action to achieve this goal.
From the Research
Referral to Orthopedics for Mildly Displaced Distal Phalanx Fracture
- A mildly displaced distal phalanx fracture may not necessarily require referral to orthopedics, as some studies suggest that non-displaced or minimally displaced fractures can be treated conservatively 2, 3.
- However, certain types of fractures, such as those involving the articular surface or avulsion of the flexor digitorum profundus tendon, may require surgical intervention 2.
- The decision to refer to orthopedics may depend on the specific characteristics of the fracture, such as the degree of displacement, the presence of rotational deformity, or the involvement of the articular surface 3, 4.
- Some studies suggest that primary care physicians can manage certain types of fractures, including non-displaced phalanx fractures, without the need for referral to an orthopedic specialist 5.
- However, if there is any concern about the fracture or the patient's symptoms, early referral to orthopedics is recommended 6.
Specific Considerations
- Mallet finger injuries, which involve a flexion deformity of the finger resulting from injury to the extensor mechanism at the base of the distal phalanx, can usually be managed with conservative treatment, but may require surgical intervention in certain cases 6.
- Fractures of the distal phalanx of the toes can often be treated conservatively, but may require surgical fixation in cases of non-union or symptomatic malunion 4.