From the Guidelines
This 12-year-old patient with an oblique extra-articular fracture of the left small finger proximal phalanx should be treated with immobilization and pain management to prioritize morbidity, mortality, and quality of life. The fact that the fracture is non-articular and minimally displaced, as indicated by the absence of discernible PIP joint involvement, suggests that simple immobilization is an appropriate treatment approach 1.
Treatment Approach
- Immobilization with a custom-made aluminum splint or commercial finger splint for 3-4 weeks is recommended, keeping the finger in a functional position (slight flexion at the MCP and PIP joints).
- Pain management can be achieved with acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg every 6-8 hours with food) 2.
- Ice the finger for 15-20 minutes several times daily for the first 48-72 hours to reduce swelling, and elevate the hand above heart level when possible.
Follow-up and Rehabilitation
- Follow-up with an orthopedic specialist or hand surgeon within 7-10 days is crucial to ensure proper alignment is maintained.
- After immobilization, gentle range-of-motion exercises should be started to prevent stiffness.
- Contact sports should be avoided for 6-8 weeks total to allow complete healing, as recommended by recent guidelines 2.
Prognosis
- The prognosis is generally good, given the fracture's extra-articular nature and the lack of PIP joint involvement.
- Children's bones tend to heal well and quickly, but careful monitoring and adherence to the treatment plan are essential to ensure optimal outcomes.
From the Research
Diagnosis and Treatment
- The patient has been diagnosed with an oblique extra-articular left small finger proximal phalangeal fracture, which is a common type of hand injury in children 3.
- The fact that there is no discernible PIP joint involvement suggests that the fracture is non-displaced or minimally displaced, and stable 4.
- Conservative management, such as splinting, is often the recommended treatment for proximal phalangeal fractures in children, especially if the fracture is stable and non-displaced 3, 4.
Rehabilitation and Recovery
- The study by 3 suggests that children with proximal phalangeal fractures who present as clinically healed at 3 weeks can be treated with a shorter immobilization period of 3 weeks, rather than the traditional 5 weeks.
- Active exercise therapy can be started immediately after the immobilization period, and patients can expect good results in mobility and grip strength 5.
- However, it's worth noting that the optimal rehabilitation protocol for proximal phalangeal fractures is still unclear, and more high-quality studies are needed to determine the best approach 5.
Surgical Intervention
- Surgical intervention may be required for unstable fracture patterns or those involving the articular surface 4, 6.
- In cases where surgical intervention is necessary, the goal is to restore anatomy and impart enough stability to allow for early motion 4.
- However, surgical dissection should be minimized to reduce soft tissue scarring and promote unobstructed tendon gliding 4.