What is the appropriate management for a 13-year-old female presenting with a fractured 4th finger?

Management of 4th Finger Fracture in a 13-Year-Old Female

For a 13-year-old female with a fractured 4th finger, conservative management with appropriate immobilization and early finger motion exercises is recommended to prevent stiffness and ensure optimal functional outcomes. 1

Initial Assessment and Imaging

• Obtain standard radiographs (anteroposterior, lateral, and oblique views) to assess:

  • Fracture pattern and stability
  • Joint involvement
  • Angulation (significant if >10 degrees)
  • Displacement or rotation 1, 2

• Key factors determining treatment approach:

  • Fracture location (distal, middle, or proximal phalanx)
  • Joint involvement (<50% joint involvement favors conservative management)
  • Stability of fracture
  • Presence of angulation, displacement, or malrotation 1, 2

Treatment Plan

For Stable, Minimally Displaced Fractures (most common in pediatric patients)

1. Immobilization:

   • Buddy taping to adjacent finger for stable fractures with <10 degrees angulation 2
   • Appropriate splinting based on fracture location:
     • For middle/proximal phalanx: splint in "safe position" (70° MCP flexion, 10° PIP/DIP flexion)
     • For distal phalanx: splint DIP joint for 4-6 weeks 2

2. Early Motion Protocol:

   • Begin early finger motion exercises as soon as pain allows to prevent edema and stiffness 3, 1
   • Encourage active and passive range of motion exercises for non-immobilized joints 1

3. Follow-up:

   • Schedule follow-up with new x-rays in 3 weeks to assess healing 1
   • Total immobilization period should not exceed 4 weeks to prevent stiffness 4

For Unstable or Significantly Displaced Fractures

• Referral to orthopedic or hand specialist for possible reduction or surgical intervention if:
  • Angulation >10 degrees
  • Significant displacement
  • Rotational deformity
  • Intra-articular involvement >50% 1, 2

Rehabilitation Protocol

1. Early Phase (0-3 weeks):

   • Maintain immobilization as prescribed
   • Begin active motion of uninvolved joints immediately
   • Educate patient/parents on edema control measures

2. Middle Phase (3-6 weeks):

   • Begin weaning from splint/immobilization
   • Implement home exercise program focusing on active and passive range of motion 1
   • Continue buddy taping for protection during activities

3. Late Phase (6+ weeks):

   • Progress to strengthening exercises
   • Gradual return to normal activities
   • Full return to sports/gymnastics when fracture is healed and full motion is restored

Pain Management

• NSAIDs for pain and inflammation control as needed 1
• Elevation of the hand to reduce swelling
• Ice for the first 48-72 hours to control pain and swelling

Potential Complications to Monitor

• Joint stiffness (most common complication)
• Malunion or delayed union
• Growth plate disturbance (if fracture involves physis)
• Chronic pain 1

Special Considerations for Pediatric Patients

• Children generally heal faster than adults and have greater remodeling potential
• Growth plate injuries require special attention to prevent growth disturbances
• Compliance with splinting and exercises may be challenging in adolescents 5

Return to Activities

• Light activities can resume once pain subsides and protective splinting is in place
• Return to sports/gymnastics should be delayed until:
  • Radiographic evidence of healing
  • Full or functional range of motion is restored
  • Adequate strength is regained

By following this protocol, most pediatric finger fractures heal well with excellent functional outcomes. The key to success is appropriate immobilization followed by early controlled motion to prevent stiffness while ensuring proper bone healing.