What is the recommended management for an adult with a non-displaced finger fracture?

Management of Adult Non-Displaced Finger Fractures

Non-displaced finger fractures in adults should be managed conservatively with appropriate immobilization and early motion therapy to prevent stiffness and optimize functional outcomes.

Initial Assessment and Treatment

• Confirm the fracture is truly non-displaced (less than 2mm displacement and less than 2-3mm step-off) 1
• Ensure there is no rotational deformity or functionally significant shortening of the finger 2
• Verify the extensor mechanism is intact and there is no significant articular surface disruption 1

Immobilization Options

1. Splinting:

   • Apply appropriate splint based on fracture location:
     • For proximal or middle phalanx fractures: Use buddy taping to adjacent finger or aluminum/thermoplastic splint
     • For distal phalanx fractures: Stack or custom-molded splint
   • Immobilize only the affected joint while allowing motion of unaffected joints 3
   • Duration: Generally 3-4 weeks, not exceeding 1 month 2

2. Follow-up:

   • Clinical and radiographic follow-up at 2-week intervals initially to assess:
     • Pain levels
     • Range of motion progress
     • Fracture healing
     • Functional improvement 1

Rehabilitation Protocol

Early Phase (0-4 weeks)

• Early finger motion is essential to prevent edema and stiffness 3
• Begin protected motion as soon as the fracture is stable (often immediately) 2
• For fingers in splints, encourage motion of uninvolved joints

Later Phase (4+ weeks)

• When immobilization is discontinued, aggressive finger and hand motion is necessary 3
• Progress to active-assisted range of motion as tolerated
• Advance to strengthening exercises after fracture healing is evident 1

Special Considerations

Pain Management

• Appropriate analgesics:
  • NSAIDs if not contraindicated
  • Limited opioids if necessary for severe pain
  • Goal: minimize opioid use 1

Indications for Surgical Referral

• Displacement greater than 2mm
• Rotational deformity
• Unstable fracture pattern
• Intra-articular extension
• Persistent symptomatic non-unions
• Disruption of tendon function 4

Prevention of Subsequent Fractures (for patients over 50)

• Consider calcium (1000-1200 mg/day) and vitamin D (800 IU/day) supplementation 1
• Implement fall prevention strategies
• Consider bone health assessment if appropriate 3, 1

Common Pitfalls to Avoid

1. Prolonged immobilization: Do not immobilize a broken finger for more than a month as this leads to stiffness and poor functional outcomes 2

2. Missed rotational deformity: Always check for proper digital cascade and rotational alignment during examination and follow-up 5

3. Inadequate radiographic evaluation: Ensure sufficient quality radiographs in multiple views to properly assess fracture pattern 2

4. Overlooking intra-articular involvement: Fractures involving the joint surface require special attention to prevent long-term dysfunction 6

5. Neglecting early motion therapy: Early protected movement is critical for optimal outcomes 3, 7