From the Guidelines
Immobilization for a proximal phalanx fracture of the little finger in an adolescent should be done with a custom-made ulnar gutter splint for 3-4 weeks, prioritizing functional support and exercise therapy to prevent stiffness and promote proper healing. The splint should immobilize both the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints while leaving the distal interphalangeal (DIP) joint free when possible.
- The finger should be positioned in the "safe position" with the MCP joint flexed at approximately 70-90 degrees and the PIP joint at about 10-15 degrees of flexion, as this helps prevent stiffness and contractures while promoting proper healing 1.
- For stable, non-displaced fractures, buddy taping to the ring finger with gauze padding between digits provides additional support while allowing some functional movement.
- After the initial immobilization period, gradual range of motion exercises should begin under the guidance of a hand therapist, as early finger motion is essential to prevent oedema and stiffness 1.
- It is essential to avoid prolonged immobilization beyond 4 weeks, as it may lead to joint stiffness, unless specifically indicated by the fracture pattern or healing progress.
- The goal of immobilization is to prevent movement that could displace bone fragments and allow the natural healing process to occur, while also considering the importance of functional support and exercise therapy to achieve better outcomes, as recommended for other types of injuries 1.
From the Research
Immobilization Methods for Proximal Phalanx Fractures
The recommended immobilization method for a proximal phalanx fracture of the little (pinky) finger in an adolescent can vary depending on the severity and type of fracture.
- For nondisplaced or minimally displaced fractures, immobilization with a splint for 3 weeks may be sufficient, as studies have shown that children who present with clinically healed proximal phalangeal fractures at 3 weeks can cease immobilization without compromising outcomes 2.
- For stable, reduced phalanx fractures, immobilization for 3 to 4 weeks after reduction of the fracture is the current standard of care 3.
- The use of a dorsopalmar plaster splint and a finger splint, with the wrist and metacarpophalangeal joints immobilized, can also be effective in achieving bony healing and free mobility 4.
Considerations for Immobilization
When immobilizing a proximal phalanx fracture, it is essential to consider the following:
- The type and severity of the fracture, as well as the patient's age and overall health 5, 3.
- The risk of complications, such as tendon entrapment, which can occur even with conservative treatment 6.
- The importance of regular follow-up and monitoring to ensure proper healing and to address any potential complications 2, 3.
Treatment Outcomes
Studies have shown that:
- Conservative management of proximal phalangeal fractures can be effective in achieving good outcomes, with low rates of documented sequelae 3.
- Functional treatment of proximal phalanx fractures can achieve bony healing and free mobility, with active exercises in the proximal and distal interphalangeal joints preventing limitations of mobility 4.
- Early detection and treatment of complications, such as tendon entrapment, are crucial to avoiding long-term disabilities 6.