What is the management of a comminuted minimally displaced fracture of the distal phalanx of the ring finger?

Management of Comminuted Minimally Displaced Fracture of the Distal Phalanx

Conservative management with protective splinting for 4-6 weeks is the recommended treatment for a comminuted minimally displaced fracture of the distal phalanx of the ring finger. 1

Initial Management

• Apply a custom-fitted finger splint that immobilizes the distal interphalangeal (DIP) joint while allowing proximal interphalangeal (PIP) joint mobility
• Splint should be worn continuously for 4-6 weeks 1
• Early finger motion of unaffected joints is essential to prevent edema and stiffness 2

Splinting Technique

• The splint should:
  • Protect the fracture site
  • Maintain proper alignment
  • Allow for some swelling
  • Be comfortable enough for patient compliance
• Stack or aluminum foam splints are commonly used options

Pain Management

• NSAIDs are recommended for pain and inflammation control 2
• Consider acetaminophen if NSAIDs are contraindicated
• Ice application for the first 48-72 hours to reduce swelling

Follow-up Care

1. Initial follow-up at 1-2 weeks to:
   • Assess swelling
   • Check splint fit
   • Ensure proper alignment is maintained
   • Evaluate skin condition under the splint
2. Radiographic follow-up at 4 weeks to confirm healing progression

Rehabilitation

• Begin gentle active range of motion exercises after splint removal (typically at 4-6 weeks)
• A directed home exercise program can be as effective as supervised therapy for uncomplicated fractures 2
• Progress to strengthening exercises once pain-free range of motion is achieved

When to Consider Surgical Management

While most distal phalanx fractures can be managed conservatively, consider surgical referral if:

• Fracture becomes displaced during treatment
• Significant joint involvement (>50% of joint surface) 2
• Open fracture with soft tissue injury
• Associated tendon injury (particularly flexor digitorum profundus avulsion) 1

Potential Complications to Monitor

• Joint stiffness
• Chronic pain
• Nail bed deformities
• Post-traumatic arthritis 2

Patient Education

• Elevate the hand above heart level when possible to reduce swelling
• Maintain motion in unaffected fingers and joints
• Avoid activities that could cause re-injury during the healing period
• Report increased pain, numbness, or color changes immediately

This management approach aligns with current guidelines that recommend conservative treatment for minimally displaced fractures of the distal phalanx, with emphasis on appropriate immobilization and early motion of unaffected joints to prevent stiffness while allowing proper healing.