What is the treatment for a fracture to the distal aspect of the proximal phalanx of the third finger?

Treatment of Fractures to the Distal Aspect of Proximal Phalanx of the Third Finger

Conservative management with buddy taping and early mobilization is the recommended first-line treatment for fractures of the distal aspect of the proximal phalanx of the third finger with less than 10 degrees of angulation, less than 50% joint involvement, and minimal displacement. 1

Assessment and Diagnosis

• Initial evaluation should include standard radiographs (anteroposterior, lateral, and oblique views) to assess fracture characteristics 1
• Key factors to evaluate:
  • Degree of angulation (critical threshold: 10 degrees)
  • Joint involvement (critical threshold: 50%)
  • Displacement
  • Stability of the fracture
  • Presence of rotation

Treatment Algorithm

For Stable Fractures (recommended for most distal proximal phalanx fractures)

1. Conservative Management:

   • Buddy taping to adjacent finger (typically to the fourth digit) 2
   • Functional splinting in the "intrinsic plus position":
     • Wrist dorsiflexed 30 degrees
     • Metacarpophalangeal joints flexed 70-90 degrees 3
   • Early active range of motion exercises for proximal and distal interphalangeal joints 3
   • Duration: 4-6 weeks 4

2. Pain Management:

   • NSAIDs for pain and inflammation control 1

For Unstable Fractures

1. Surgical Intervention (Open Reduction and Internal Fixation) is indicated for:

   • Angulation >10 degrees
   • Displacement
   • Malrotation
   • Unstable fractures 1, 5

2. Fixation Options:

   • Kirschner wire fixation for transverse and short oblique fractures 5
   • Plate fixation for comminuted fractures 5
   • Lag screws for spiral long oblique fractures 5

Rehabilitation Protocol

• Begin active range of motion exercises immediately for conservatively managed fractures 3
• For surgically managed fractures, early finger motion exercises should be initiated as soon as stable fixation allows 1
• Directed home exercise program to prevent stiffness 1

Expected Outcomes and Complications

• With proper management, most patients achieve full range of motion (86% in one study) 3
• Potential complications to monitor:
  • Joint stiffness (most common)
  • Chronic pain
  • Recurrent instability
  • Post-traumatic arthritis
  • Extensor lag 1

Follow-up Recommendations

• Regular assessment of fracture healing with radiographs
• Monitoring of finger mobility and function
• Assessment for complications such as malrotation or angulation 1

Important Considerations

• The ring finger is most commonly affected by proximal phalanx fractures, but the principles apply to the third finger as well 3
• The goal of functional treatment is to achieve bone healing and free mobility simultaneously, not sequentially 3
• Biomechanical studies show that for unstable fractures requiring fixation, different pin configurations provide similar resistance to shortening 6

Common Pitfalls to Avoid

• Prolonged immobilization leading to stiffness
• Failure to identify and address malrotation early
• Inadequate pain control limiting early mobilization
• Overlooking associated soft tissue injuries

The evidence strongly supports functional treatment with early mobilization for most proximal phalanx fractures, as this approach prevents limitations in mobility while allowing for proper bone healing 3, 2.