What is the treatment for a Salter-Harris (Salter-Harris fracture, a type of fracture that involves the growth plate) 1 fracture of the fifth proximal phalanx?

Treatment of Salter-Harris Type 1 Fracture of Fifth Proximal Phalanx

Conservative management with buddy taping and immediate mobilization is the recommended treatment for Salter-Harris type 1 fractures of the fifth proximal phalanx. 1

Understanding Salter-Harris Fractures

Salter-Harris fractures are injuries unique to childhood that involve the growth plate (physis). They are classified into five types 2:

• Type I: Fracture through the growth plate only
• Type II: Fracture through the growth plate and metaphysis
• Type III: Fracture through the growth plate and epiphysis
• Type IV: Fracture through the growth plate, epiphysis, and metaphysis
• Type V: Crush or compression injury of the growth plate

Treatment Algorithm

Initial Assessment

1. Pain management

   • Implement multimodal analgesia including regular acetaminophen and cautious use of opioids if needed 3
   • Apply cold therapy (ice) for 20-30 minutes, 3-4 times daily (never directly on skin) 3

2. Fracture evaluation

   • Assess for any rotational deformity or significant displacement
   • Check for any signs of nail bed injury if the fracture is near the distal phalanx 4

Treatment Steps for Salter-Harris Type 1 Fracture of Fifth Proximal Phalanx

1. Perform gentle closed reduction if there is displacement

   • Align the fracture fragments as anatomically as possible 1

2. Apply buddy taping

   • Tape the injured fifth finger to the adjacent fourth finger 1
   • This provides adequate stabilization while allowing immediate mobilization

3. Encourage immediate mobilization

   • Active exercises of the interphalangeal joints should begin immediately 5
   • This helps prevent limitations of mobility and subsequent rotational or axial deformities 5

4. Avoid prolonged immobilization

   • Traditional static treatment with plaster casting can lead to limitation of mobility in the interphalangeal joints 5
   • The goal is to achieve bony healing and free mobility simultaneously, not in succession 5

Expected Outcomes

With proper buddy taping and early mobilization, patients can expect:

• High overall satisfaction
• Minimal to no pain at rest or during activities
• Full flexion in most cases
• Satisfactory extension
• No nonunion or delayed union 1

Follow-up Care

1. Regular monitoring

   • Follow up at 1-2 weeks to ensure proper alignment and healing
   • Continue buddy taping for 3-4 weeks until clinical healing is evident

2. Rehabilitation

   • Encourage continued range of motion exercises
   • Gradually increase activities as pain allows

Potential Complications

While most Salter-Harris fractures heal without permanent deformity, be aware of these possible complications:

• Growth arrest (rare in type 1 fractures)
• Malrotation (occurs in approximately 5-6% of cases) 1
• Limited range of motion if inadequate early mobilization

Important Considerations

• The intrinsic plus position (metacarpophalangeal joints flexed 70-90 degrees) helps stabilize proximal phalanx fractures by making the extensor aponeurosis taut 5
• Active exercises prevent limitations of mobility and subsequent occurrence of rotational and axial deformities 5
• While some fractures may benefit from surgical intervention, Salter-Harris type 1 fractures of the fifth proximal phalanx generally respond well to conservative management 1

This approach focuses on functional outcomes rather than perfect radiographic alignment, which has shown excellent results in terms of patient satisfaction and recovery 1.