What is the recommended treatment for a 66-year-old patient with a non-displaced fracture through the terminal phalanx tuft?

From the Guidelines

The recommended treatment for a 66-year-old patient with a non-displaced fracture through the terminal phalanx tuft is primarily conservative management. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of conservative treatment for non-displaced fractures, especially in older adults 1. Conservative management typically includes immobilization with a protective splint for 3-4 weeks, adequate pain control with acetaminophen 500-1000mg every 6 hours or ibuprofen 400-600mg every 6-8 hours as needed, and elevation of the affected finger to reduce swelling.

Key Considerations

• The splint should protect the fingertip while allowing for proximal interphalangeal joint motion to prevent stiffness.
• Any associated subungual hematoma should be drained if painful by trephination (creating a small hole in the nail).
• The patient should be advised to keep the wound clean and dry if there is an open injury.
• Follow-up should occur at 2-3 weeks to assess healing progress. These fractures generally heal well with conservative treatment because the terminal phalanx has an excellent blood supply.

Additional Recommendations

• Surgery is rarely needed unless there is significant displacement, joint involvement, or an open fracture with soft tissue damage.
• The patient can typically return to normal activities gradually after 4-6 weeks, though complete bone healing may take 6-8 weeks.
• Ensuring adequate calcium and vitamin D intake is crucial for bone health, especially in older adults, as recommended by recent guidelines 1.
• A multidisciplinary approach, including orthogeriatric care, may be beneficial for elderly patients with fragility fractures, as suggested by EULAR/EFORT recommendations 1.

From the Research

Treatment Options for Non-Displaced Fracture through the Terminal Phalanx Tuft

• The treatment of phalangeal fractures, including those of the terminal phalanx tuft, depends on various factors such as the characteristics of the fracture, the condition of the soft tissue envelope, associated injuries, patient functional requirements, and surgeon familiarity with different techniques 2.
• For non-displaced fractures, conservative management is often recommended, with careful soft tissue handling and early mobilization being key premises of treatment 2, 3.
• In cases where the fracture is stable and there is no significant soft tissue injury, nonoperative treatment can be successful 4.
• However, if there is any soft tissue injury, open reduction and internal fixation may be advisable to ensure proper healing and minimize complications 4.

Considerations for the 66-Year-Old Patient

• The patient's age and overall health status should be taken into account when determining the best course of treatment.
• While the provided studies do not specifically address the treatment of non-displaced terminal phalanx tuft fractures in elderly patients, the general principles of phalangeal fracture management can still be applied.
• It is essential to consider the patient's functional requirements and potential for rehabilitation when deciding between conservative and operative treatment options.

Potential Treatment Approaches

• Buddy taping and a rigid-sole shoe may be used to limit joint movement and promote healing in stable, nondisplaced toe fractures, which could be applicable to similar fractures of the finger 5.
• However, the specific treatment approach for a non-displaced fracture through the terminal phalanx tuft in a 66-year-old patient would depend on individual factors and should be determined by a qualified healthcare professional.