What is the recommended management for a distal phalanx tuft fracture?

Management of Distal Phalanx Tuft Fractures

Distal phalanx tuft fractures should be managed conservatively with protective splinting and attention to soft tissue injury, as they rarely require specific treatment for the fracture itself. 1

Initial Assessment and Management

• Obtain radiographs to evaluate:

  • Size and displacement of fracture fragment
  • Presence of associated injuries
  • Evidence of joint instability 2

• For indeterminate cases, CT without IV contrast may be considered to better visualize:

  • Fracture morphology
  • Fragment size and displacement
  • Associated occult fractures 2

Treatment Approach

Conservative Management

• Most distal phalanx tuft fractures can be managed conservatively as they typically result from crushing injuries where soft tissue management is the priority 1
• Protective splinting for comfort and protection:
  • Splint should protect the fracture while allowing for early mobilization
  • Splints are optimal for acute injuries with anticipated swelling 2
• Ice application during the first 3-5 days for symptomatic relief 2

Special Considerations

• Displaced articular fractures on the palmar side require special attention:
  • These are often associated with flexor digitorum profundus tendon avulsion
  • May require surgical fixation 1
• Dorsal articular fractures (mallet fractures) can typically be treated non-operatively 1

Rehabilitation Protocol

• Begin active finger motion exercises immediately after diagnosis to prevent stiffness 2
• Progressive range of motion exercises after the immobilization period 2
• Average immobilization duration is approximately 3-4 weeks 2
• A directed home exercise program is recommended after the immobilization period 2

Complications and Considerations

• Potential complications include:

  • Chronic pain
  • Joint stiffness
  • Muscle atrophy
  • Complex regional pain syndrome 2

• Non-union is rare but has been reported:

  • Cases of non-union may require surgical intervention with Kirschner wire fixation and bone grafting 3
  • However, this is extremely uncommon for tuft fractures 1

• Avoid excessive immobilization to prevent stiffness and complications 2

Special Patient Populations

• Children have higher tolerance for immobilization and faster healing rates 2
• In adolescent athletes (e.g., sport climbers), stress fractures of the distal phalanx may occur and can typically be managed conservatively 4
• Evaluate elderly patients for osteoporosis risk and consider calcium/vitamin D supplementation 2

Emergency Considerations

• If a fractured extremity appears blue, purple, or pale, activate emergency services immediately
• Cover open wounds with clean dressing to prevent contamination and infection 2