What type of splint is recommended for a small base proximal phalanx fracture?

Splinting for Small Base Proximal Phalanx Fracture

For a small base proximal phalanx fracture, buddy taping with immediate mobilization is the recommended splinting method, which provides adequate stabilization while preserving finger function. 1

Assessment and Classification

Before selecting a splint, proper evaluation is essential:

• Obtain standard radiographs (anteroposterior, lateral, and oblique views) to confirm the diagnosis and assess fracture characteristics 2
• Evaluate for:
  • Degree of displacement (less than 10 degrees angulation is favorable for conservative management)
  • Joint involvement (less than 50% involvement indicates conservative management)
  • Stability of the fracture
  • Presence of malrotation

Splinting Options Based on Fracture Characteristics

For Stable, Minimally Displaced Fractures (Most Small Base Fractures)

1. Buddy Taping (Preferred Method)

   • Tape the injured finger to an adjacent uninjured finger (typically to the ring finger if the small finger is injured) 1
   • Allows immediate mobilization while providing adequate stability
   • Demonstrated high patient satisfaction and excellent functional outcomes 1

2. Dorsopalmar Plaster Splint with Finger Splint

   • Position the wrist in 30 degrees dorsiflexion
   • Metacarpophalangeal (MCP) joints flexed 70-90 degrees (intrinsic plus position)
   • This position tightens the extensor aponeurosis, providing natural splinting of the proximal phalanx 3

For Unstable or Significantly Displaced Fractures

If the fracture shows:

• Angulation greater than 10 degrees
• Displacement with interfragmentary gap >3mm
• Significant malrotation

Consider:

• Reduction and more rigid immobilization
• Referral for possible surgical intervention 2, 4

Duration of Splinting

• Maintain splinting for 4-6 weeks for uncomplicated fractures 5
• Begin active range of motion exercises immediately if using buddy taping 1
• If using more rigid immobilization, active exercises of the interphalangeal joints should begin as soon as possible to prevent stiffness 2, 3

Monitoring and Follow-up

• Regular assessment of fracture healing with follow-up radiographs
• Monitor for complications:
  • Joint stiffness
  • Malrotation
  • Delayed union
  • Post-traumatic arthritis 2

Pitfalls and Caveats

• Avoid prolonged rigid immobilization as it often leads to decreased mobility despite exact fracture reduction 1, 3
• Watch for malrotation which occurred in a small percentage of patients (3 out of 53) even with conservative management 1
• Prioritize function over perfect anatomical reduction for these fractures, as functional outcomes are generally excellent even with some radiographic imperfection 1
• Be cautious with pediatric juxta-epiphyseal fractures which may require different management approaches due to growth plate considerations 6

Pain Management

• NSAIDs are recommended for pain and inflammation control 2
• Use analgesic narcotics with caution due to side effects such as sedation, nausea, and risk of falls 2

The evidence strongly supports that conservative management with buddy taping allows for immediate mobilization while providing adequate stability for healing, resulting in excellent functional outcomes for small base proximal phalanx fractures 1, 3.