What is the treatment for an undisplaced comminuted fracture of the distal phalanx of the great toe, consistent with a crush injury?

From the Guidelines

Treatment for an undisplaced comminuted midshaft fracture of the distal phalanx of the great toe typically involves conservative management, as surgery is usually reserved for cases with significant displacement, joint involvement, or open fractures 1. The primary treatment includes rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours to reduce swelling and pain.

• Pain management with acetaminophen (500-1000 mg every 6 hours) or NSAIDs like ibuprofen (400-600 mg every 6-8 hours) for 5-7 days is recommended unless contraindicated.
• The toe should be protected using buddy taping to the adjacent toe with gauze padding between toes to prevent skin maceration, which should be continued for 3-4 weeks.
• A rigid-soled shoe or post-operative shoe can provide additional protection and comfort while walking.
• Weight-bearing is typically allowed as tolerated, but patients should avoid high-impact activities for 4-6 weeks. The fracture usually heals within 6-8 weeks, and this conservative approach is effective because the great toe's distal phalanx has good blood supply and the undisplaced nature of the fracture means bone fragments remain in proper alignment.
• Follow-up should occur at 2-3 weeks to ensure proper healing, and antibiotics are not typically necessary unless there is an open fracture, in which case early delivery of antibiotics is suggested to lower the risk of deep infection 1.

From the Research

Treatment of Undisplaced Comminuted Midshaft Fracture of the Distal Phalanx of the Great Toe

• The provided studies do not directly address the treatment of an undisplaced comminuted midshaft fracture of the distal phalanx of the great toe.
• However, the treatment principles for crush injuries and comminuted fractures can be applied to this type of injury.
• For crush injuries, treatment options include closed reduction and isolated K-wire fixation, limited open reduction and internal fixation with K-wires, screw fixation, spanning external fixation, or combinations of these techniques 2, 3, 4.
• In the case of comminuted fractures, limited internal fixation combined with external fixation may be difficult or impossible due to the small size and large number of bony fragments 2.
• A temporary internal bridge plating technique may provide adequate temporary internal stabilization until bony healing occurs 2.
• The use of external fixation and primary wound closure has been reported in the treatment of open comminuted fractures, with successful outcomes 5.
• The treatment of comminuted midshaft clavicle fractures using a minimally invasive technique has also been reported, with high consolidation rates and low complication rates 6.

Considerations for Treatment

• The importance of maintaining the stability of the medial longitudinal arch of the foot should be considered in the treatment of foot injuries 2, 4.
• The location and extent of the injury, as well as the patient's ability to ambulate with a reasonably normal gait, should also be taken into account 4.
• The potential for complications, such as pin tract infections, should be considered when using external fixation 2.