What is the treatment for a fractured finger in a 15-year-old?

Treatment for Fractured Finger in a 15-Year-Old

Conservative management with appropriate immobilization is the recommended first-line treatment for most finger fractures in adolescents, with surgical intervention reserved only for unstable or significantly displaced fractures.

Initial Assessment and Diagnosis

• Standard radiographs (3 views: anteroposterior, lateral, and oblique) are essential to assess the fracture pattern, displacement, and angulation 1
• Physical examination should evaluate for:
  • Rotational deformity (check finger alignment when partially flexed)
  • Angulation (should be less than 10 degrees)
  • Displacement (should be less than 3mm)
  • Joint stability
  • Neurovascular status

Treatment Algorithm

For Stable, Minimally Displaced Fractures (Most Common in Adolescents)

1. Immobilization options:

   • Buddy taping to adjacent finger for stable fractures with minimal angulation (<10 degrees) 2
   • Splinting for 4-6 weeks depending on fracture location 2
   • Recent evidence shows removable splints are as effective as casts for pediatric phalangeal fractures with better comfort and hygiene 3

2. Location-specific treatment:

   • Distal phalanx fractures: Splint the distal interphalangeal (DIP) joint for 4-6 weeks 2
   • Middle/proximal phalanx fractures: Buddy splinting if angulation is <10 degrees 2
   • Mallet finger (dorsal avulsion fracture): Strict splint immobilization for 8 weeks 2

For Unstable or Significantly Displaced Fractures

• Referral to orthopedic or hand surgeon is indicated for:
  • Angulation >10 degrees
  • Displacement >3mm
  • Rotational deformity
  • Unstable fractures
  • Intra-articular fractures involving >50% of joint surface 1, 2

Rehabilitation and Follow-up

1. Early mobilization:

   • Begin active range of motion exercises within 3-7 days after injury for stable fractures 4
   • Early mobilization prevents stiffness and promotes better functional outcomes 1

2. Follow-up schedule:

   • Clinical and radiographic assessment at 4-6 weeks to confirm healing 1
   • Monitor for alignment, growth disturbance, and function

3. Home exercise program:

   • Directed exercises including active motion to prevent stiffness 1
   • Gradual return to activities as healing progresses

Potential Complications

• Joint stiffness (most common complication)
• Malunion or nonunion
• Post-traumatic arthritis
• Chronic pain
• Growth disturbance (relevant in adolescents with open growth plates)

Important Considerations

• Immobilization should not exceed one month to prevent joint stiffness 5
• Simple fractures with appropriate treatment typically result in normal range of motion 4
• Associated injuries (tendon damage, crush injury, skin loss) significantly worsen outcomes 4
• Pediatric finger fractures have remarkable remodeling potential, especially in younger children 3

Common Pitfalls to Avoid

1. Failing to recognize rotational deformity, which can cause functional impairment
2. Prolonged immobilization leading to stiffness and decreased function
3. Inadequate radiographic views missing subtle fractures
4. Delayed referral for unstable fractures requiring surgical intervention
5. Overlooking associated soft tissue injuries that may affect outcomes