What type of splint is recommended for pediatric nondisplaced proximal fourth and fifth phalanges fractures?

From the Guidelines

For pediatric nondisplaced proximal fourth and fifth phalanges fractures, an ulnar gutter splint is the recommended immobilization method. This recommendation is based on the principle of immobilizing the affected area to promote proper healing while allowing for some functional use of the unaffected parts of the hand. The ulnar gutter splint is specifically designed to immobilize the fourth and fifth digits, which are the ones affected by proximal fourth and fifth phalanges fractures, while allowing the thumb, index, and middle fingers to maintain some level of functionality.

Key Considerations for Splint Application

• The splint should be applied with the metacarpophalangeal (MCP) joints flexed at approximately 70-90 degrees and the interphalangeal (IP) joints in slight flexion, commonly referred to as the "safe position" 1.
• The splint should extend from the fingertips to the mid-forearm, covering the ulnar aspect of the hand and wrist.
• Immobilization typically lasts 3-4 weeks for children, which is shorter than for adults due to children's faster healing rates.

Rationale for Ulnar Gutter Splint

The ulnar gutter splint is preferred because it effectively immobilizes the fourth and fifth digits while allowing some functional use of the thumb, index, and middle fingers. This design helps maintain proper alignment of the fracture while preventing rotation deformities that could lead to malunion. Although studies such as 1 and 1 discuss the treatment of distal radius fractures, which is a different condition, the principle of immobilization for fracture healing is relevant. However, for pediatric nondisplaced proximal fourth and fifth phalanges fractures, the focus is on maintaining alignment and preventing complications without necessarily requiring the rigid immobilization discussed for distal radius fractures.

Follow-Up and Monitoring

Regular follow-up at 1-2 weeks is important to ensure the fracture remains properly aligned and to check for any complications such as excessive swelling or skin problems under the splint. This monitoring is crucial for adjusting the treatment plan as necessary to ensure optimal healing and minimize the risk of long-term morbidity. While studies like 1 highlight the complexities and variabilities in treating different types of fractures, the core principle of appropriate immobilization and monitoring remains a cornerstone of fracture management.

From the Research

Splint Options for Pediatric Nondisplaced Proximal Fourth and Fifth Phalanges Fractures

• The treatment for pediatric nondisplaced proximal fourth and fifth phalanges fractures can vary, but evidence suggests that splinting is a viable option 2.
• A study comparing casting versus splinting for nonoperative treatment of pediatric phalangeal neck fractures found no significant difference in clinical and radiologic outcomes between the two methods 2.
• Splinting has the added benefits of increased comfort and hygiene, making it a recommended alternative for nonoperative treatment of Al Qattan type I and type II phalangeal fractures 2.
• Another study found that buddy taping with immediate mobilisation can be an effective treatment for base fractures of the fifth proximal phalanx, with high patient satisfaction and minimal complications 3.
• A randomized controlled trial comparing buddy taping versus splint immobilization for paediatric finger fractures found that buddy taping was non-inferior to splinting, with higher patient comfort and lower cost 4.
• The choice of splint may depend on the specific fracture and patient needs, but options include:
  • Removable splints 2
  • Buddy taping 3, 4
  • Dorsopalmar plaster splint 5
• It is essential to consider the individual patient's needs and fracture characteristics when selecting a splinting method.