What is the recommended treatment for a small finger proximal phalanx base fracture, specifically using an ulnar gutter splint?

Management of Small Finger Proximal Phalanx Base Fractures with Ulnar Gutter Splint

For small finger proximal phalanx base fractures, an ulnar gutter splint with buddy taping to the ring finger and immediate mobilization is the recommended treatment approach for stable fractures with minimal displacement. 1

Initial Assessment and Indications for Splinting

The management of proximal phalanx base fractures depends on fracture stability and displacement:

• Stable fractures suitable for splinting:

  • Less than 50% joint involvement
  • Minimal displacement (less than 10 degrees angulation)
  • No interfragmentary gap >3mm
  • No malrotation 2

• Unstable fractures requiring surgical intervention:

  • Displacement with interfragmentary gap >3mm
  • Significant angulation (>10 degrees)
  • Malrotation
  • Fractures involving more than 50% of the articular surface 2

Splinting Technique

1. Ulnar gutter splint application:

   • Position the wrist in slight extension (20-30 degrees)
   • Maintain the metacarpophalangeal (MCP) joint in 70-90 degrees of flexion
   • Keep the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in slight flexion
   • Extend the splint from mid-forearm to fingertips on the ulnar side

2. Buddy taping enhancement:

   • Tape the small finger to the ring finger to provide additional stability while allowing controlled motion 1
   • This combination of ulnar gutter splint with buddy taping provides stability while enabling early controlled mobilization

Rehabilitation Protocol

The splinting approach should follow a dynamic treatment protocol:

1. Initial phase (0-2 weeks):

   • Maintain the ulnar gutter splint
   • Begin early protected motion of the PIP and DIP joints to prevent stiffness 3

2. Intermediate phase (2-4 weeks):

   • Transition to buddy taping alone
   • Continue with active range of motion exercises
   • Monitor for proper alignment and healing

3. Final phase (4-6 weeks):

   • Continue buddy taping until clinical union is achieved
   • Implement a directed home exercise program including active motion exercises 2

Monitoring and Follow-up

• Radiographic evaluation at 1-2 weeks to ensure maintained alignment
• Clinical assessment of:
  • Digital rotation
  • Range of motion
  • Pain levels
  • Functional use

Potential Complications and Pitfalls

• Joint stiffness: The most common complication; prevented by early protected mobilization 2
• Malrotation: Carefully assess for rotational alignment during initial splinting and follow-up 1
• Flexor tendon entrapment: Rare but serious complication requiring surgical intervention if motion is significantly limited 4
• Delayed union or nonunion: Uncommon with proper immobilization techniques 1

Special Considerations

• Pain management: NSAIDs are recommended for pain and inflammation control 2
• Monitoring for hypothermia: Particularly important in pediatric patients when using cooling for associated soft tissue injuries 5
• Wound care: Cover any open wounds with clean dressings to prevent contamination and infection 5

This approach balances the need for fracture stability with early mobilization, which has been shown to provide excellent functional outcomes with high patient satisfaction and minimal complications in proximal phalanx base fractures of the small finger 1.