What is the treatment for a fracture of the distal phalanx in a 5-year-old child?

From the Guidelines

For a fracture of the distal phalanx in a 5-year-old child, I strongly recommend simple immobilization as the primary treatment, as it is appropriate for small, nonarticular, or minimally displaced fractures, according to the American College of Foot and Ankle Surgeons 1. This approach is based on the principle that most pediatric fractures, especially those of the distal phalanx, heal well with conservative management due to the excellent bone healing capacity and remodeling potential in children. The immobilization can be achieved with a protective splint applied to the injured finger, extending from the fingertip past the distal interphalangeal joint, keeping the finger in a functional position. Key aspects of care include:

• Pain management with weight-based acetaminophen (10-15 mg/kg every 4-6 hours as needed) or ibuprofen (5-10 mg/kg every 6-8 hours as needed)
• Elevating the hand above heart level for the first 48 hours to reduce swelling
• Follow-up with a pediatric orthopedist or hand specialist within 7-10 days to ensure proper healing
• Monitoring for signs of complications such as increasing pain, numbness, color changes, or nail deformities It's crucial to note that fractures involving the nail bed or open fractures may require additional interventions like nail bed repair or wound care. Generally, these fractures heal within 3-4 weeks, emphasizing the importance of careful observation and timely intervention if complications arise, as supported by the principles outlined in the diagnosis and treatment guidelines 1.

From the Research

Treatment Options for Fracture of the Distal Phalanx in a 5-year-old Child

• The management of phalangeal fractures, including those of the distal phalanx, is based on the initial severity of the injury and depends on the success of closed reduction techniques 2, 3.
• Nondisplaced phalanx fractures are typically managed with splint immobilization 2, 3.
• Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction 2, 3.
• Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning 2, 3.
• One study suggests that locked extra-articular DIP pinning is a simple and reproducible surgical treatment for distal phalanx fractures, with good outcomes in terms of pain, range of motion, and hand strength 4.

Considerations for Nonoperative Treatment

• For nonoperative treatment of pediatric phalangeal neck fractures, both casting and splinting are viable options, with no significant difference in radiologic outcomes between the two 5.
• Splinting may have added benefits of increased comfort and hygiene, making it a suitable alternative to casting 5.

Specifics to Distal Phalanx Fractures

• The treatment of distal phalanx fractures must consider the fracture type and surrounding soft tissues, including the nail bed and nail plate 6.
• The outcome of treatment depends on the type of fracture and the surrounding structures, with radiologically unsatisfying results and longer rehabilitation times possible after both operative and conservative therapy 6.