From the Guidelines
Treatment for a mildly displaced oblique fracture of the diaphysis of the fourth proximal phalanx should involve simple immobilization, as surgery is typically reserved for more complex cases with significant displacement or articular involvement 1. When managing such fractures, the primary goal is to achieve proper alignment and stability while minimizing morbidity and promoting optimal quality of life.
- Key considerations include:
- Immobilization to prevent further displacement and allow healing
- Pain management to improve patient comfort and adherence to treatment
- Regular follow-up to monitor fracture alignment and adjust treatment as necessary Given the mild displacement of the fracture, conservative management is appropriate, and simple immobilization is the recommended initial treatment approach 1.
- This may involve the use of a splint or other immobilizing device to maintain proper alignment of the fracture fragments.
- Additionally, pain management with medications such as acetaminophen or ibuprofen, as well as elevation and ice application to reduce swelling, can help improve patient comfort and outcomes. It is essential to monitor the fracture closely with regular follow-up and radiographs to ensure that the alignment is maintained and that the fracture is healing properly.
- If there are any signs of worsening displacement or other complications, surgical intervention may be necessary to prevent long-term morbidity and mortality.
From the Research
Treatment Options for Mildly Displaced Oblique Fracture of the Diaphysis of the Fourth Proximal Phalanx
- The treatment for a mildly displaced oblique fracture of the diaphysis of the fourth proximal phalanx can vary depending on the degree of displacement and the stability of the fracture reduction 2.
- For inherently stable fractures, no surgical treatment may be required, while other fractures may need additional stabilization 2.
- Kirschner wires and screw-and-plate fixation are common methods of internal fixation for proximal phalanx fractures 2.
- Transverse and short oblique proximal phalanx fractures can be treated with Kirschner wires, while a stable short oblique transverse shaft fracture can be managed with an intrinsic plus splint 2.
- Early closed reduction is typically successful for unicondylar fractures of the head of the proximal phalanx, while bicondylar proximal phalanx fractures are usually treated with plate fixation 2.
Conservative Management
- Conservative functional treatment can be an effective approach for managing proximal phalanx fractures, aiming to achieve bony healing and free mobility simultaneously 3.
- This method involves immobilizing the wrist and metacarpophalangeal joints with a plaster cast, while allowing mobilization of the proximal interphalangeal joints 3.
- Buddy taping and immediate mobilization can also be used for conservative management of base fractures in the proximal phalanx, particularly for the fifth digit 4.
Surgical Intervention
- Percutaneous, antegrade pinning can be used to treat proximal phalangeal fractures, with early active postoperative motion allowing for earlier return to work and improved DASH scores 5.
- A single extra-articular percutaneous Kirschner wire can be used to stabilize fractures at the junction of the diaphysis and metaphysis of the proximal phalanges, with mobilization of the proximal inter-phalangeal joints until wire removal 6.