What is the recommended treatment for a minimally displaced Salter II fracture of the proximal phalanx of the ring finger in a 12-year-old male (YOM - Year Old Male)?

Treatment of Minimally Displaced Salter II Fracture of Proximal Phalanx in 12-Year-Old Male

For a minimally displaced Salter II fracture of the proximal phalanx of the ring finger in a 12-year-old male, closed reduction and splinting is the recommended treatment approach, with careful attention to maintaining proper alignment and early mobilization of uninvolved joints. 1, 2

Initial Management

• Assessment: Evaluate for:

  • Rotational deformity (check digital cascade)
  • Coronal malalignment
  • Neurovascular status
  • Range of motion limitations

• Imaging: Obtain anteroposterior, lateral, and oblique radiographs to confirm fracture pattern and degree of displacement 3

Treatment Algorithm

For Minimally Displaced Fractures (angulation <10°)

1. Closed reduction if needed to optimize alignment

2. Immobilization options:

   • Dorsopalmar plaster splint with the wrist in 30° dorsiflexion and metacarpophalangeal (MCP) joints in 70-90° flexion (intrinsic plus position) 4
   • This position tightens the extensor aponeurosis over the proximal phalanx, providing natural splinting of the fracture

3. Immobilization duration: 4-6 weeks 3

4. Early finger motion:

   • Encourage early motion of uninvolved joints (distal interphalangeal and proximal interphalangeal joints) to prevent stiffness 5
   • Active exercises help prevent limitations of mobility and subsequent rotational or axial deformities 4

For More Displaced Fractures (angulation >10°)

• Consider closed reduction with percutaneous Kirschner wire fixation if:
  • Reduction cannot be maintained with splinting alone
  • There is significant displacement or angulation
  • Rotational deformity is present 2

Monitoring and Follow-up

• Regular radiographic assessment: Check at 1-2 weeks to ensure maintenance of reduction
• Watch for complications:
  • Malunion leading to "pseudo-claw" deformity 2
  • Joint stiffness (most common complication) 5
  • Growth disturbance (angular deformity or length discrepancy) 5
  • Flexor tendon entrapment (rare but serious complication) 6

Special Considerations for Pediatric Patients

• The unmineralized physis is biomechanically weaker than surrounding structures, making these fractures common in children 1
• Growth plate injuries require careful monitoring to prevent growth disturbances
• Expected recovery time is typically 6-8 weeks for full healing 5
• Consider vitamin C supplementation to help manage pain 5

Rehabilitation

• Directed home exercise program including active finger motion exercises to prevent stiffness 5
• Gradual return to activities as healing progresses
• Avoid activities that cause pain in the injured finger 5

Pitfalls and Caveats

• Avoid prolonged rigid immobilization as it can lead to joint stiffness, a critical adverse effect 5
• Monitor for rotational deformity which can be difficult to detect on standard radiographs but causes functional impairment
• Watch for loss of reduction during follow-up, especially in the first 1-2 weeks
• Consider surgical intervention if closed reduction fails to maintain adequate alignment

This approach balances the need for fracture healing with preservation of hand function, which is particularly important in a growing child.