From the Guidelines
The treatment for a nondisplaced fracture of the distal phalanx of the small finger typically involves simple immobilization, as surgery is usually reserved for more complex cases with significant displacement or articular involvement 1. When managing a nondisplaced fracture of the distal phalanx of the small finger, the primary goal is to promote healing while maintaining function and minimizing complications.
- Immobilization with a custom-made or pre-fabricated finger splint for 3-4 weeks is a common approach, keeping the finger protected in a slightly flexed position to maintain function.
- Pain management is crucial and can include acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food) for the first 5-7 days.
- Additional measures such as ice application for 15-20 minutes several times daily during the first 48-72 hours and elevation of the hand above heart level when possible can help reduce swelling and pain.
- After the immobilization period, gentle range-of-motion exercises should begin to prevent stiffness, gradually increasing activity as pain allows.
- It is essential to note that while most nondisplaced distal phalanx fractures heal well with conservative management, fractures involving the nail bed, joint surface, or those with significant displacement may require orthopedic or hand specialist evaluation 1.
- Patients should be advised that complete healing typically takes 6-8 weeks, though minor residual swelling and discomfort may persist longer.
From the Research
Treatment for Nondisplaced Fracture of the Distal Phalanx
- The treatment for a nondisplaced fracture of the distal phalanx of the small (fifth) finger typically involves splinting of the distal interphalangeal joint for four to six weeks 2.
- This approach is generally recommended for uncomplicated distal phalanx fractures caused by a crush injury to the end of the finger 2.
- The goal of treatment is to allow for proper healing of the fracture while minimizing complications and promoting early mobilization 3, 4.
- In some cases, careful soft tissue handling and early mobilization may be necessary to achieve optimal functional outcomes 4.
- It's worth noting that fractures of the distal phalanx, except for those of the articular surface, are often sustained in crushing injuries and may require care for the surrounding soft tissues rather than specific treatment for the fracture itself 5.
Specific Considerations
- If the fracture is associated with other injuries, such as avulsion of the flexor digitorum profundus tendon, surgical treatment may be necessary 5, 6.
- In rare cases, avulsion injury of the flexor digitorum profundus and the flexor digitorum superficialis tendons may occur, requiring two-stage flexor tendon graft 6.
- Early diagnosis and treatment are crucial to achieving optimal outcomes and minimizing the risk of complications 2, 3, 4, 5, 6.