What is the treatment for a nondisplaced fracture of the distal phalanx that is not forming callus?

Treatment for Nondisplaced Fracture of Distal Phalanx Not Forming Callus

For a nondisplaced fracture of the distal phalanx that is not forming callus, surgical intervention with open reduction and Kirschner wire fixation is recommended to promote bone healing and prevent long-term functional disability. 1

Diagnostic Evaluation

When evaluating a distal phalanx fracture with delayed healing:

• Standard radiographic examination should include:

  • 3 views of the affected finger (PA, lateral, and oblique projections) 2
  • An internally rotated oblique projection may increase diagnostic yield for phalangeal fractures 2

• If initial radiographs are inconclusive:

  • CT without IV contrast can be used to better evaluate fracture characteristics 2
  • MRI is usually not indicated for digital fractures but may be considered if soft tissue injury is suspected 2

Treatment Algorithm

Initial Management

1. Confirm fracture stability and alignment with proper radiographic views
2. Evaluate for factors that may contribute to non-union:
   • Inadequate immobilization
   • Soft tissue interposition
   • Poor blood supply
   • Infection

For Nondisplaced Distal Phalanx Fractures Not Forming Callus

When a nondisplaced distal phalanx fracture shows no evidence of callus formation despite appropriate initial management:

1. Surgical intervention is indicated:

   • Open reduction and internal fixation with Kirschner wire 1
   • This approach has been shown to successfully treat troublesome non-union of distal phalanx shaft fractures

2. Postoperative management:

   • Active finger motion exercises should be initiated following surgery to prevent stiffness 2
   • Finger stiffness is one of the most functionally disabling adverse effects of hand fractures 2

Special Considerations

• Associated soft tissue injuries: Evaluate for potential flexor tendon injuries, which may be present with distal phalanx fractures and require specific treatment 3

• Fracture location:

  • Shaft fractures of the distal phalanx should be treated with the same principles as shaft fractures of middle and proximal phalanges 1
  • Tuft fractures (more distal) typically require less aggressive intervention 4

Rehabilitation

• Initiate active finger motion exercises as soon as possible to prevent stiffness 2
• Instructing patients to move fingers regularly through complete range of motion helps minimize complications 2
• Finger motion does not adversely affect adequately stabilized fractures 2

Potential Complications

• Finger stiffness: Can be very difficult to treat after fracture healing, requiring multiple therapy visits and possibly additional surgical intervention 2

• Missed associated injuries: Early diagnosis of associated tendon injuries may be missed due to the presence of a nondisplaced fracture 3

• Persistent non-union: Can lead to chronic pain, decreased function, and potential deformity if not properly addressed 1

By addressing a non-healing distal phalanx fracture with appropriate surgical intervention and rehabilitation, functional outcomes can be significantly improved and long-term disability prevented.