From the Guidelines
A non-displaced middle phalanx fracture typically does not require surgery. Most non-displaced fractures of the middle phalanx can be effectively treated with conservative management, which includes immobilization using a finger splint for 3-4 weeks. The splint should be applied with the finger in a functional position, usually with a slight bend at the joints. Pain management can be achieved with over-the-counter medications like acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food). Ice application for 15-20 minutes several times daily during the first 48-72 hours can help reduce swelling. After the immobilization period, gentle range-of-motion exercises should be started to prevent stiffness.
Surgery becomes necessary only if the fracture is displaced (bone fragments are out of alignment), unstable, involves the joint surface significantly, or fails to heal properly with conservative treatment. Non-displaced fractures heal well without surgery because the bone fragments remain in their proper anatomical position, allowing the natural healing process to occur effectively while maintaining proper finger function. According to the most recent and highest quality study available, which is focused on a different type of fracture but provides relevant insight into the principles of fracture management, conservative management is often preferred for non-displaced or minimally displaced fractures 1.
Key points to consider in the management of non-displaced middle phalanx fractures include:
- Immobilization to allow proper healing
- Pain management to ensure patient comfort
- Early mobilization to prevent stiffness
- Monitoring for any signs of displacement or complications that might necessitate surgical intervention. Given the information provided and the focus on minimizing morbidity, mortality, and maximizing quality of life, the approach to non-displaced middle phalanx fractures should prioritize conservative management, reserving surgery for cases where it is absolutely necessary, such as displacement or failure of conservative treatment 1.
From the Research
Non-Displaced Middle Phalanx Fracture Treatment
- A non-displaced middle phalanx fracture may not require surgery, as nonsurgical management is the preferred treatment for stable, extra-articular fractures of the proximal and middle phalanx 2.
- Nonsurgical management typically involves splint immobilization for nondisplaced phalanx fractures, and stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction 3.
- However, the decision for operative treatment depends on various fracture characteristics, such as the degree of articular step or gap, likelihood of subluxation or dislocation, and unstable fractures 4.
Fracture Characteristics and Surgical Decision-Making
- The assessment of a 2-mm articular step or gap, subluxation or dislocation, and percentage of articular surface involved are reliable and useful for surgical decision-making 4.
- Articular step or gap, likelihood of subluxation or dislocation, and unstable fractures are most strongly associated with the decision for operative treatment 4.
- Surgeons largely agree on which fractures might benefit from surgery, and the variation seems to be with the operative technique 4.
Operative Treatment Options
- Open reduction with internal fixation with plate fixation is most often chosen for unstable phalangeal shaft fractures in high-demand athletes to provide rigid internal fixation and allow immediate range of motion and more rapid return to sport 2.
- An internal joint stabilizer for unstable injuries to the base of the middle phalanx provides satisfactory functional outcomes, allows early postoperative motion, and mitigates the routine complications which may arise with external fixation 5.
- Intramedullary headless compression screw fixation is a technically simple, effective, and minimally invasive technique for treating fractures of the proximal and middle phalanges 6.