What is the recommended splint choice for a proximal 5th phalanx base displaced fracture?

Splint Choice for Proximal 5th Phalanx Base Displaced Fracture

The optimal splint choice for a proximal 5th phalanx base displaced fracture is buddy taping to the 4th digit with immediate mobilization. 1

Rationale for Buddy Taping

Buddy taping to the adjacent 4th digit provides several advantages for managing proximal 5th phalanx base fractures:

• Allows for immediate mobilization which promotes better functional outcomes
• Prevents stiffness that can occur with rigid immobilization
• Accommodates swelling better than rigid casts
• Enables skin inspection and hygiene 2
• Results in high patient satisfaction and excellent functional outcomes 1

Evidence-Based Management Protocol

1. Initial Assessment:

   • Confirm diagnosis with standard radiographs (posteroanterior, lateral, and 45° semipronated oblique views) 2
   • Assess for displacement, angulation, and rotation
   • Evaluate neurovascular status

2. Reduction:

   • Perform closed reduction if necessary before buddy taping
   • Ensure proper alignment with minimal angulation (aim for <10 degrees) 3

3. Immobilization Method:

   • Apply buddy taping to the 4th digit
   • Ensure proper alignment without malrotation
   • Begin immediate protected mobilization 1

4. Duration of Treatment:

   • Maintain buddy taping for approximately 3-4 weeks 2
   • Clinical and radiographic reassessment at 2-3 weeks to evaluate healing progression

5. Rehabilitation:

   • Active finger motion exercises should begin immediately to prevent stiffness 2
   • Progressive strengthening exercises after the immobilization period

Clinical Outcomes with Buddy Taping

Research by Sloth et al. (2014) demonstrated excellent outcomes with buddy taping for proximal 5th phalanx base fractures 1:

• High overall patient satisfaction
• Full flexion recovery in nearly all patients (52 of 53)
• Minimal pain at rest or work
• No nonunion or delayed unions
• Only 3 cases of malrotation, none requiring corrective surgery

Alternative Splinting Options

For cases with significant instability or when buddy taping is contraindicated:

1. Custom-molded thermoplastic splint:

   • Two-component design allowing motion of the interphalangeal joints
   • Permits bone healing and motion recovery simultaneously
   • Can be removed for wound care and radiographic evaluation 4

2. Isometric traction splint:

   • Effective for controlling alignment and rotation
   • Not recommended for compression-type fractures due to risk of tenodesis effect 5

Important Considerations and Pitfalls

• Avoid rigid immobilization when possible as it can lead to:

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

• Monitor for complications:

  • Malrotation (check for digit overlap when making a fist)
  • Loss of reduction
  • Delayed healing

• Special populations:

  • For diabetic patients: monitor skin closely to prevent pressure points 2
  • For elderly patients: evaluate for osteoporosis 2
  • For athletes: discuss realistic timeline for return to sports 2

• Pain management:

  • NSAIDs for pain and inflammation control
  • Ice application during first 3-5 days 2

Follow-up Recommendations

• Reassess at 2-3 weeks for fracture healing progression
• Evaluate range of motion and grip strength
• If healing is progressing well, continue buddy taping for full 3-4 weeks
• Begin progressive strengthening exercises after immobilization period

By implementing buddy taping with immediate mobilization for proximal 5th phalanx base displaced fractures, you can achieve excellent functional outcomes while avoiding the complications associated with rigid immobilization.