What is the treatment for a 6-year-old with a distal left fifth toe fracture (5th toe) with mild displacement, who is able to ambulate with mild pain?

From the Guidelines

The treatment for a 6-year-old with a distal left fifth toe fracture with mild displacement, who is able to ambulate with mild pain, is primarily conservative management with simple immobilization, as surgery is usually reserved for more severe cases 1. The recommended approach is buddy taping the injured toe to the adjacent 4th toe using cloth tape with cotton padding between the toes to prevent skin irritation.

• This immobilization should be maintained for 3-4 weeks, with tape changes every few days or when soiled.
• Pain management can include weight-appropriate doses of acetaminophen (10-15 mg/kg every 4-6 hours as needed) or ibuprofen (5-10 mg/kg every 6-8 hours with food).
• The child should wear comfortable, wide-toed shoes to avoid pressure on the fracture site. Parents should monitor for increased pain, swelling, or skin changes that might indicate complications, as most pediatric toe fractures heal well with this approach due to children's excellent healing capacity and the non-weight-bearing nature of the 5th toe 1.
• It is essential to follow up with a healthcare provider to ensure proper healing and to address any concerns or complications that may arise.
• The diagnosis is based on a history of trauma and focal pain on palpation and is confirmed with radiographic studies, which is crucial for determining the appropriate treatment plan 1.

From the Research

Treatment for Distal Left Fifth Toe Fracture

The treatment for a 6-year-old with a distal left fifth toe fracture with mild displacement, who is able to ambulate with mild pain, can be determined based on the following evidence:

• For stable, nondisplaced toe fractures, treatment with buddy taping and a rigid-sole shoe to limit joint movement is recommended 2.
• For displaced fractures of the lesser toes, treatment with reduction and buddy taping is suggested 2.
• There is limited evidence on the specific treatment for a distal left fifth toe fracture with mild displacement in a pediatric patient, but the general principles of treatment for toe fractures can be applied 2, 3, 4.
• In cases where the fracture is not adequately aligned or is unstable, referral to a specialist may be necessary for further evaluation and treatment 2.
• The treatment approach may vary depending on the individual patient's condition and the severity of the fracture, and should be determined by a qualified healthcare professional 2, 3, 4.

Considerations for Pediatric Patients

• Pediatric patients with fractures of the physis may require referral to a specialist, but selected nondisplaced Salter-Harris types I and II fractures may be treated by family physicians 2.
• The treatment approach for pediatric patients with toe fractures should take into account the patient's age, overall health, and activity level 2, 3, 4.

Additional Considerations

• The patient's ability to ambulate with mild pain suggests that the fracture is stable and can be treated conservatively, but ongoing monitoring and evaluation are necessary to ensure proper healing 2.
• The treatment plan should be individualized to the patient's specific needs and circumstances, and may involve a combination of conservative and surgical approaches 2, 3, 4.