How long should a proximal phalanx base fracture of the fifth finger be immobilized?

Immobilization Duration for Proximal Phalanx Base Fracture of Fifth Finger

The proximal phalanx base fracture of the fifth finger should be immobilized for 3-4 weeks, followed by progressive rehabilitation exercises. 1, 2

Treatment Approach

Initial Management

• Conservative treatment with buddy taping to the fourth digit is recommended for most proximal phalanx base fractures of the fifth finger 2
• Immobilization should be in the "intrinsic plus" position:
  • Wrist dorsiflexed 30 degrees
  • Metacarpophalangeal joints flexed 70-90 degrees 3
• This position tightens the extensor aponeurosis, providing natural splinting of the fracture 3

Immobilization Duration

• Average immobilization duration is 3-4 weeks 1, 4
• Clinical and radiographic reassessment should occur at 2-3 weeks to evaluate fracture healing progression 1
• For pediatric patients, immobilization for 3-4 weeks after reduction is the standard of care 4

Post-Immobilization Care

• Directed home exercise programs should be implemented immediately after the immobilization period 1
• Progressive range of motion exercises should begin after immobilization to prevent stiffness 1
• Full recovery is typically expected within 6-8 weeks 1

Evidence Strength and Considerations

The recommendation for 3-4 weeks of immobilization is supported by multiple sources. A 2024 study of pediatric proximal phalanx base fractures confirms that 3-4 weeks of immobilization is the current standard of care 4. This is consistent with the Praxis Medical Insights guidelines that suggest an average immobilization duration of 3-4 weeks 1.

A 2014 study specifically examining base fractures of the fifth proximal phalanx demonstrated excellent outcomes with buddy taping and immediate mobilization, suggesting that even shorter immobilization periods may be effective for certain stable fractures 2.

Important Caveats

• Fracture stability is a key consideration:

  • Unstable fractures may require surgical fixation with K-wires or other methods 5, 6
  • Displaced fractures with tendon entrapment require surgical intervention 6

• Potential complications to monitor:

  • Malrotation (scissoring of digits) occurs in approximately 0.93% of cases 4
  • Joint stiffness is the most common complication, especially with prolonged immobilization 3
  • Flexor tendon entrapment is rare but serious 6

• The goal of treatment should be to achieve both bony healing and free mobility simultaneously rather than sequentially 3

Rehabilitation Protocol

1. Weeks 0-3/4: Immobilization with splint or buddy taping
2. Weeks 3/4-6: Begin active range of motion exercises
3. Weeks 6-8: Add strengthening exercises for intrinsic hand muscles
4. Beyond 8 weeks: Return to full activities as tolerated

This approach balances the need for adequate immobilization to ensure proper healing while minimizing the risk of stiffness and other complications associated with prolonged immobilization.