What is the recommended treatment for a 23-year-old female with a comminuted, non-displaced intra-articular fracture of the distal phalanx of the right great toe?

Treatment for Comminuted, Non-Displaced Intra-Articular Fracture of the Distal Phalanx of the Right Great Toe

Conservative management with immobilization using buddy taping and a rigid-soled shoe is the recommended treatment for a non-displaced intra-articular fracture of the distal phalanx of the right great toe in a 23-year-old female.

Assessment and Initial Management

Diagnostic Confirmation

• Standard radiographs (anteroposterior and oblique views) are the initial imaging of choice to confirm fracture characteristics and rule out associated injuries 1
• Ensure the fracture is truly non-displaced and intra-articular before proceeding with treatment

Conservative Management Protocol

1. Immobilization:

   • Buddy taping of the great toe to the adjacent toe to provide stability
   • Provision of a rigid-soled shoe or post-operative shoe to limit joint movement and protect the toe 2
   • Average immobilization duration: 3-4 weeks 1

2. Pain Management:

   • NSAIDs for pain and inflammation control 1
   • Ice application during the first 3-5 days for symptomatic relief 1
   • Oral analgesics as needed for breakthrough pain

3. Follow-up Care:

   • Clinical and radiographic reassessment at 2-3 weeks to evaluate fracture healing progression 1
   • Total expected healing time: approximately 4-6 weeks

Rehabilitation Phase

After the immobilization period (typically 3-4 weeks):

• Implement directed home exercise program 1
• Begin progressive range of motion exercises 1
• Full recovery is typically expected within 6-8 weeks 1

Indications for Surgical Intervention

While conservative management is appropriate for this patient, be aware of scenarios that would warrant surgical referral:

• Development of displacement during treatment
• Signs of nonunion (persistent pain and/or instability after 8-12 weeks)
• Open fractures
• Significant soft tissue injury
• Fracture-dislocations

If surgical intervention becomes necessary, options include:

• Open reduction and interfragmentary screw fixation, which has shown good outcomes for symptomatic nonunion of distal phalangeal fractures 3
• K-wire fixation for unstable fractures 4

Potential Complications and Monitoring

• Monitor for signs of:
  • Malunion
  • Nonunion
  • Joint stiffness
  • Post-traumatic arthritis
  • Nail deformity (if nail bed was involved)

Special Considerations

• Ensure proper patient education on immobilization device use and care 1
• Discuss realistic timeline for return to normal activities and sports 1
• Advise on weight-bearing limitations during the healing period

Pitfalls to Avoid

1. Misdiagnosis: Ensure the fracture is truly non-displaced before proceeding with conservative management
2. Inadequate immobilization: Proper buddy taping technique and rigid-soled shoe are essential
3. Overlooking associated injuries: Check for nail bed injuries or soft tissue damage
4. Delayed follow-up: Timely reassessment is crucial to identify any displacement or healing problems

Remember that while most non-displaced intra-articular fractures of the distal phalanx heal well with conservative management, close monitoring is essential to ensure proper healing and to identify any complications early.