From the Research
The treatment for injuries at the base of the middle phalanges of the 3rd and 4th fingers typically involves buddy taping the injured finger to an adjacent uninjured finger for 3-4 weeks, along with pain management and rehabilitation. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of immobilization and proper positioning to prevent long-term dysfunction 1.
Key Considerations
- Initial management includes buddy taping to provide stability while healing occurs, with pain control achieved through acetaminophen or ibuprofen for the first few days.
- Ice application for 15-20 minutes several times daily during the first 48-72 hours helps reduce swelling.
- For more severe injuries like fractures or complete ligament tears, a hand specialist evaluation is necessary, as these may require splinting with a dorsal aluminum splint in slight flexion or possibly surgical intervention.
- After the immobilization period, gentle range-of-motion exercises should be initiated to prevent stiffness, gradually progressing to strengthening exercises using therapy putty or small hand exercisers.
Evidence-Based Recommendations
The most recent study on common finger fractures and dislocations 1 provides guidance on the management of uncomplicated middle and proximal phalanx fractures, which can be treated with buddy splinting if there is minimal angulation. However, larger angulations, displacement, and malrotation often require reduction or surgery. Other studies, such as those on pediatric phalanx fractures 2 and reconstruction of the middle phalangeal base using an osteocartilaginous autograft from the hamate 3, provide additional insights into the management of phalangeal fractures, but the study by 1 remains the most relevant and recent guide for the treatment of injuries at the base of the middle phalanges of the 3rd and 4th fingers. An evidence-based guide for managing phalangeal fractures 4 also supports the use of immobilization, pain management, and rehabilitation in the treatment of these injuries. Overall, the treatment approach should prioritize immobilization, pain management, and rehabilitation to optimize outcomes and prevent long-term dysfunction.