What is the recommended treatment for significant interval healing of an oblique midshaft left 4th proximal phalanx fracture?

Management of Oblique Midshaft Left 4th Proximal Phalanx Fracture with Significant Interval Healing

For a proximal phalanx fracture with significant interval healing, early active motion therapy with protective splinting is recommended to optimize functional outcomes while allowing continued bone healing.

Assessment of Fracture Stability

When evaluating a proximal phalanx fracture with significant interval healing, the following factors should be considered:

1. Fracture characteristics:

   • Oblique midshaft fractures are typically more stable than transverse fractures 1
   • The presence of significant interval healing indicates good progression toward union

2. Imaging evaluation:

   • Standard radiographs (minimum 3 views) should be used to assess healing progress 2
   • CT may be considered if more detailed assessment of healing is needed 2

Treatment Approach

Non-Operative Management

For proximal phalanx fractures showing significant interval healing, non-operative functional treatment is appropriate in most cases:

• Dynamic treatment approach 3:

  • Use of a dorsopalmar splint that immobilizes the wrist and metacarpophalangeal joints
  • Position the wrist in 30 degrees dorsiflexion
  • Position metacarpophalangeal joints in 70-90 degrees flexion (intrinsic plus position)
  • This position tightens the extensor aponeurosis over the proximal phalanx, providing natural splinting

• Early controlled motion:

  • Begin active interphalangeal joint exercises while maintaining fracture stability 3
  • This approach aims to achieve bone healing and restore mobility simultaneously rather than sequentially

Rehabilitation Protocol

1. Early phase (during continued healing):

   • Active finger exercises of the proximal and distal interphalangeal joints while in protective splinting 2
   • Avoid aggressive physical therapy that might disrupt healing 2

2. Progressive phase:

   • Gradually increase range of motion exercises
   • Begin gentle strengthening exercises once healing is more advanced

3. Final phase:

   • Progress to full active and passive range of motion
   • Implement hand strengthening exercises

Monitoring and Follow-up

• Regular radiographic assessment at 2,6, and 12 weeks to monitor healing progression 4
• Assess for:
  • Fracture alignment
  • Progressive callus formation
  • Any signs of delayed union

Potential Complications to Monitor

1. Joint stiffness: The most common complication of proximal phalanx fractures, especially when treated with prolonged immobilization 5

2. Malunion: Can lead to rotational or angular deformity affecting hand function 6

3. Tendon adhesions: May limit gliding of flexor or extensor tendons 6

Special Considerations

• For patients with higher functional demands (e.g., athletes, musicians), more aggressive rehabilitation may be warranted once adequate healing is confirmed 7

• If there are signs of healing problems or displacement during follow-up, reassessment and possible surgical intervention should be considered 1

Key Takeaway

The goal of treatment for a healing proximal phalanx fracture is to maintain the fracture alignment while promoting early motion to prevent stiffness. The intrinsic plus position splinting with active interphalangeal joint motion has shown excellent outcomes with high rates of fracture union and good functional recovery 3.