From the Guidelines
The appropriate management for a distal phalangeal fracture of the second toe typically involves conservative treatment, as the fracture fragments are small and minimally displaced, allowing for simple immobilization to facilitate healing. The management plan should include buddy taping the injured toe to an adjacent toe, using gauze or cotton between the toes to prevent skin maceration, as well as pain control with acetaminophen 650 mg every 6 hours or ibuprofen 400-600 mg every 6-8 hours as needed for 3-5 days 1. Some key considerations for the management of this condition include:
- Immobilization to provide stability and allow the fracture to heal
- Elevation of the foot when possible and application of ice for 15-20 minutes several times daily for the first 48-72 hours to reduce swelling
- Weight-bearing as tolerated, with a wide, stiff-soled shoe recommended to minimize movement of the toe during walking
- Monitoring for signs of complications, such as infection or significant displacement, which may require surgical intervention Healing typically occurs within 3-6 weeks, and this conservative approach is supported by the fact that distal phalangeal fractures of the toes are generally stable and have good blood supply, promoting effective healing without surgical intervention 1. In this case, since the small triangular fracture fragment is about 5 mm in maximum diameter and distracted about 2 mm from the remainder of the phalanx, and the larger component of the distal phalanx is subluxed about 2 mm dorsomedially, conservative management is the most appropriate course of action.
From the Research
Management of Distal Phalangeal Fracture of the Second Toe
The management of a distal phalangeal fracture of the second toe can be determined based on the severity and displacement of the fracture.
- For stable, nondisplaced fractures, treatment may involve buddy taping and a rigid-sole shoe to limit joint movement 2.
- For displaced fractures, reduction and buddy taping may be necessary 2.
- In cases of intra-articular fractures, referral to a specialist may be indicated for further evaluation and treatment 2.
- The use of a custom-molded splint system, such as the one described in 3, may be beneficial in allowing bone healing and recovery of motion simultaneously.
- It is essential to evaluate the fracture and develop a treatment plan based on the individual case, taking into account the severity of the injury and the patient's overall health.
Considerations for Treatment
- The treatment of phalangeal fractures, including those of the toe, aims to restore function while limiting the risk of complications 4.
- An understanding of anatomical and mechanical principles is integral to achieving a successful outcome 4.
- The management of phalangeal fractures in pediatric patients may differ from that in adults, with a focus on closed reduction techniques and splint immobilization for nondisplaced fractures 5.
- In cases of open physeal fractures, such as Seymour fractures, suture-only stabilization may be a viable treatment option 6.