Management of Mildly Displaced Fifth Proximal Phalanx Metaphysis Fracture (Salter-Harris Type II)
The initial management for a mildly displaced fifth proximal phalanx metaphysis fracture comparable to a Salter-Harris type II fracture should be conservative treatment with buddy taping and immediate mobilization. 1
Diagnostic Approach
Before initiating treatment, proper diagnosis is essential:
Standard 3-view radiographic examination of the hand is indicated as the initial imaging for suspected hand trauma 2
- Posteroanterior (PA)
- Lateral
- Oblique views
For phalangeal injuries specifically:
- Some centers include PA examination of the entire hand
- Others limit examination to the injured finger
- An internally rotated oblique projection increases diagnostic yield for phalangeal fractures 2
Treatment Algorithm
1. Conservative Management (First-Line)
For mildly displaced fractures:
- Buddy taping to the adjacent (fourth) digit 1
- Immediate mobilization to preserve function
- This approach focuses on function rather than exact anatomical reduction
Benefits of conservative management:
- High overall patient satisfaction
- Minimal pain at rest or during activities
- Excellent recovery of flexion (nearly all patients regain full flexion)
- No cases of nonunion or delayed union 1
2. Surgical Management (Reserved for specific cases)
Consider surgical intervention only if:
- Fracture is unstable
- Significant displacement persists after closed reduction
- Rotational deformity is present
Surgical options when indicated:
- Single extra-articular percutaneous Kirschner wire passed lateral to the metacarpal head into the phalanx base across the fracture 3
- Metacarpophalangeal joint splinted in flexion with mobilization of proximal interphalangeal joints until wire removal (typically at 24 days) 3
Special Considerations for Pediatric Patients
Salter-Harris type II injuries in children have excellent outcomes with conservative management:
- These fractures are common in children aged 10-14 years 4
- The unmineralized physis is biomechanically weaker than surrounding structures 4
- Even in very young children (as young as 3 years), conservative management has shown successful outcomes with no sequelae 5
Monitoring and Follow-up
Regular follow-up to assess:
- Maintenance of acceptable alignment
- Range of motion
- Signs of malrotation (which occurred in only 3 of 53 patients in one study) 1
- Proper healing
Watch for potential complications:
- Pin site infections (if surgical management was chosen) 3
- Malrotation
- Extension deficits
Pitfalls to Avoid
- Overtreatment: Internal fixation often leads to decreased mobility despite exact reduction 1
- Undertreatment: Failure to recognize unstable fractures that truly require surgical intervention
- Inadequate monitoring: Even conservative treatment requires appropriate follow-up
- Delayed mobilization: Early movement is key to good functional outcomes
This approach prioritizes functional outcomes over perfect radiographic alignment, which is particularly appropriate for fifth digit injuries where some minor malunion can be well tolerated without significant functional deficit.