Appropriate Splint for Acute Nondisplaced Salter-Harris Type 2 Fracture of the Proximal Phalanx of the 4th Digit
A posterior splint (back-slab) is the most appropriate splint for an acute nondisplaced Salter-Harris type 2 fracture of the proximal phalanx of the 4th digit. 1
Rationale for Posterior Splinting
Nondisplaced Salter-Harris type 2 fractures of the proximal phalanx can be effectively managed with conservative treatment through proper immobilization. The American Academy of Orthopaedic Surgeons specifically recommends posterior splinting for these injuries 1. This approach provides several benefits:
- Maintains fracture alignment while allowing for appropriate healing
- Reduces pain and prevents further injury
- Facilitates safe transport to medical facilities 2
- Prevents rotational deformity that could lead to functional impairment
Alternative Splinting Option
In some cases, buddy taping to the adjacent digit (3rd finger) may be considered as an alternative or adjunct to posterior splinting, particularly when:
- The fracture is completely stable
- There is minimal swelling
- Early mobilization is desired
Research has shown that buddy taping can provide adequate stabilization while allowing for immediate mobilization in certain phalangeal fractures 3. However, this approach is more commonly used for fractures of the 5th digit rather than the 4th digit.
Important Clinical Considerations
When applying the posterior splint:
- Immobilize the affected digit in a functional position (slight flexion)
- Include both the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in the splint
- Ensure the splint does not constrict circulation
- Monitor for signs of poor perfusion (blue, purple, or pale extremity) which would require immediate medical attention 2
Monitoring and Follow-up
- Immobilization should typically be maintained for 3-4 weeks 4
- Regular radiographic follow-up is essential to ensure proper healing and alignment
- Monitor for potential complications such as:
- Malrotation (scissoring of digits)
- Angular deformity
- Growth disturbance due to physeal injury
Diagnostic Imaging
Prior to splinting, proper diagnosis through imaging is crucial:
- A standard 3-view radiographic examination of the hand (PA, lateral, and oblique views) is sufficient for diagnosis 2, 1
- An internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for phalangeal fractures 2
Prognosis
With appropriate splinting and immobilization, the prognosis for nondisplaced Salter-Harris type 2 fractures of the proximal phalanx is generally excellent. Research shows that these fractures rarely require surgical management and can typically be treated with conservative measures 4. The risk of growth disturbance is minimal when properly managed.