What is the management for a minimally displaced oblique fracture of the proximal phalanges of the right third toe?

Management of Minimally Displaced Oblique Fracture of the Proximal Phalanx of the Right Third Toe

Conservative management with buddy taping to the adjacent toe and immediate mobilization is the recommended treatment for minimally displaced oblique fractures of the proximal phalanx of the third toe.

Diagnostic Assessment

1. Radiographic evaluation:

   • Standard 3-view radiographic examination is necessary to confirm the diagnosis 1
   • Views should include:
     • Anteroposterior (AP)
     • Lateral
     • Oblique views

2. Assessment parameters:

   • Degree of displacement
   • Fracture pattern (oblique)
   • Stability of the fracture
   • Presence of rotation
   • Joint involvement

Treatment Algorithm

First-line Treatment: Conservative Management

For minimally displaced oblique fractures of the proximal phalanx of the third toe:

1. Buddy taping technique:

   • Tape the injured third toe to the adjacent fourth toe 2
   • Use non-adhesive material between the toes to prevent skin maceration
   • Ensure taping is not too tight to avoid circulatory compromise
   • Change taping regularly to maintain hygiene

2. Immediate mobilization:

   • Allow weight-bearing as tolerated
   • Encourage early range of motion exercises within pain limits
   • Use comfortable, wide-toed footwear to accommodate swelling

3. Pain management:

   • Simple analgesics such as acetaminophen
   • NSAIDs if not contraindicated
   • Elevation of the foot when at rest
   • Ice application for the first 48-72 hours

Follow-up Protocol

1. Initial follow-up at 1-2 weeks to:

   • Assess pain levels
   • Check for proper alignment
   • Evaluate for any rotation deformity
   • Ensure buddy taping is being used correctly

2. Radiographic follow-up:

   • At 3-4 weeks to confirm healing progression
   • At cessation of immobilization (typically 4-6 weeks) 1

3. Expected outcomes:

   • Full range of motion should be regained
   • Minimal to no pain at rest or with activity
   • Return to normal footwear within 4-6 weeks

Special Considerations

When to Consider Surgical Management

Surgery is generally not indicated for minimally displaced fractures of the toe phalanges but may be considered if:

1. Significant displacement occurs during follow-up
2. Malrotation is present and causing functional issues
3. Non-union or delayed union occurs
4. Patient experiences persistent pain or functional limitation

Potential Complications

1. Malrotation
2. Stiffness
3. Chronic pain
4. Delayed union or non-union (rare in toe phalanges)

Evidence Basis

The recommendation for conservative management with buddy taping is supported by research showing excellent outcomes for proximal phalanx fractures treated with this approach. A prospective study of 53 patients with base fractures of the proximal phalanx demonstrated high overall satisfaction, minimal pain, and good functional outcomes with buddy taping and immediate mobilization 2. All but one patient regained full flexion, and no non-unions or delayed unions occurred.

While much of the literature focuses on hand fractures, the principles of treatment for minimally displaced phalangeal fractures can be applied to toe fractures as well. The goal of treatment is to allow fracture healing in acceptable alignment while maintaining motion 3.

Conservative management avoids the potential complications associated with surgical intervention, such as infection, hardware problems, and excessive scarring, while achieving comparable functional outcomes for minimally displaced fractures.