Management of Non-Displaced Mildly Impacted Salter-Harris II 5th Proximal Phalanx Fracture in an 11-Year-Old Boy
The non-displaced mildly impacted Salter-Harris II fracture of the 5th proximal phalanx in an 11-year-old boy should be treated conservatively with buddy taping and early mobilization.
Assessment and Diagnosis
When evaluating this fracture:
- Assess for digital cascade to check for rotational deformity or coronal malalignment
- Confirm fracture pattern on plain radiographs (AP and oblique views)
- Evaluate for any signs of displacement, angulation, or rotation
Treatment Algorithm
Primary Management
Conservative treatment with buddy taping
- Buddy tape the 5th digit to the 4th digit 1
- Use appropriate padding between digits to prevent skin maceration
- Tape should be snug but not constrictive to maintain circulation
Immobilization considerations
- For comfort, a short period (1-2 weeks) of protective splinting may be beneficial
- Avoid prolonged rigid immobilization as this may lead to stiffness 1
Early mobilization
- Begin active range of motion exercises as soon as pain allows
- Early mobilization helps prevent stiffness and promotes better functional outcomes 1
Follow-up Protocol
- First follow-up at 7-10 days to:
- Assess pain control
- Check for any displacement or malrotation
- Evaluate range of motion
- Repeat radiographs to ensure maintenance of alignment
- Continue buddy taping for 3-4 weeks total
- Final follow-up at 4-6 weeks to confirm healing and full function
Clinical Rationale
The conservative approach is supported by evidence showing that:
- Salter-Harris II fractures of the proximal phalanx are the most common type of finger fracture in children 2
- Non-displaced phalanx fractures can be successfully managed with splint immobilization 2
- Base fractures of the proximal phalanx treated with buddy taping and immediate mobilization show high satisfaction rates and good functional outcomes 1
Special Considerations
When to Consider Referral
Referral to a hand specialist would be indicated if:
- Evidence of displacement develops during treatment
- Rotational deformity is present
- Intra-articular involvement exceeds 25% of the joint surface
- Open fracture or significant soft tissue injury 3
- Signs of growth disturbance develop during follow-up
Potential Complications
- Growth disturbance (monitor for 6-12 months)
- Malrotation (check by having patient flex fingers - they should point toward the scaphoid)
- Stiffness (minimize with early protected motion)
- Malunion (rare with appropriate initial management of non-displaced fractures)
Patient/Parent Education
- Explain the nature of the injury and expected healing time (3-4 weeks)
- Demonstrate proper buddy taping technique for home care
- Advise on pain management with appropriate over-the-counter medications
- Instruct on warning signs requiring immediate attention (increasing pain, numbness, color changes)
- Provide guidance on gradual return to activities and sports (typically 4-6 weeks)
This approach prioritizes functional outcomes while minimizing the risks associated with more invasive treatments, which is particularly important in pediatric hand injuries where growth and development are ongoing concerns.