What is the treatment for a non-displaced distal phalanx fracture of the small finger?

Treatment of Non-Displaced Distal Phalanx Fracture of the Small Finger

Non-displaced distal phalanx fractures of the small finger should be treated with protective splinting of the distal interphalangeal joint for 4-6 weeks, with active range of motion exercises of the uninvolved joints to prevent stiffness. 1

Initial Assessment

• Confirm diagnosis with proper radiographic evaluation
  • Standard 3-view radiographic examination (PA, lateral, and oblique views) is typically sufficient 2
  • An internally rotated oblique projection increases diagnostic yield for phalangeal fractures 2

Treatment Algorithm

Immobilization

• Splint the distal interphalangeal (DIP) joint only
• Keep the middle and proximal interphalangeal joints free to maintain mobility
• Splinting duration: 4-6 weeks 1
• Use a custom-made or pre-fabricated fingertip splint that:
  • Protects the fracture site
  • Prevents further displacement
  • Allows for wound care if there is associated soft tissue injury

Active Motion Protocol

• Begin active range of motion exercises for uninvolved joints immediately
• This is critical to prevent finger stiffness, which is one of the most functionally disabling complications 2
• Instruct the patient at the first encounter to move the uninvolved finger joints regularly through complete range of motion 2

Pain Management

• Simple analgesics as needed
• Ice application in the first few days to reduce swelling

Follow-up Care

• Clinical reassessment at 2-3 weeks
• Radiographic follow-up to confirm healing before discontinuing immobilization
• Consider longer immobilization if:
  • Patient reports continued pain
  • Clinical examination reveals tenderness at fracture site
  • Follow-up radiographs show incomplete healing

Special Considerations

• Assess for associated nail bed injuries or subungual hematomas
• If there is an open fracture or significant soft tissue injury, wound care takes priority
• Monitor for signs of infection if there is an open wound

When to Refer

• Development of displacement during treatment
• Signs of malunion or nonunion
• Associated tendon injuries (particularly flexor digitorum profundus avulsion)
• Complex intra-articular fractures

Pitfalls to Avoid

1. Prolonged immobilization of uninjured joints, which can lead to stiffness
2. Failure to recognize associated soft tissue injuries
3. Inadequate follow-up to ensure proper healing
4. Overlooking rotational deformity which can significantly impact hand function

Finger stiffness is extremely difficult to treat after fracture healing and may require multiple therapy visits or additional surgical intervention 2. Therefore, early motion of uninvolved joints is essential for optimal outcomes.