What is the recommended splint for a comminuted fracture of the proximal phalanx of the big toe?

Recommended Splint for Comminuted Fracture of Proximal Phalanx of Big Toe

For a comminuted fracture of the proximal phalanx of the big toe, splinting in the position found with buddy taping to the adjacent toe and use of a rigid-soled shoe is recommended to reduce pain, prevent further injury, and facilitate healing. 1

Assessment and Initial Management

• Comminuted fractures of the proximal phalanx of the big toe typically result from crushing injuries, axial force, or direct trauma 2
• Clinical evaluation should focus on point tenderness at the fracture site and pain with gentle axial loading of the digit 2
• Assess for signs requiring immediate emergency response:
  • Blue, purple, or pale appearance of the toe (indicating poor perfusion) 1
  • Open fractures with severe bleeding 1

Imaging Considerations

• Anteroposterior and oblique radiographs are generally most useful for identifying toe fractures, determining displacement, and evaluating adjacent structures 2
• For complex comminuted intraarticular fractures, CT imaging may provide better visualization of fracture fragments and aid in treatment planning 1, 3

Splinting Technique

• The fracture should be treated in the position found unless straightening is necessary for safe transport 1
• Recommended splinting approach:
  • Buddy taping to the adjacent toe to provide stability 2
  • Use of a rigid-soled shoe to limit joint movement and protect the fracture site 2
  • The splint should immobilize the toe without compromising circulation 1

Special Considerations

• For open fractures:

  • Cover with a clean dressing to reduce risk of contamination and infection 1
  • Consider antibiotic prophylaxis based on wound severity 1

• For displaced fractures:

  • Gentle reduction may be attempted prior to splinting 2
  • If reduction is unstable or unsuccessful, referral for surgical management may be necessary 2

Indications for Referral

• Circulatory compromise 1
• Open fractures 1
• Significant soft tissue injury 2
• Fracture-dislocations 2
• Displaced intra-articular fractures 2, 3
• Unstable fractures or those involving more than 25% of the joint surface 2

Duration of Splinting and Follow-up

• Maintain splinting for approximately 4-6 weeks, depending on fracture severity and healing progress 3, 4
• Follow-up radiographs should be obtained to assess healing at 2-3 weeks 2
• Once adequate healing is observed, range of motion exercises can be initiated to prevent stiffness 3

Potential Complications

• Nonunion (particularly with severely comminuted fractures) 5
• Joint degeneration (especially with intraarticular fractures) 5
• Growth disturbances (in pediatric patients with epiphyseal involvement) 6

Common Pitfalls to Avoid

• Overtightening the splint, which can compromise circulation 1
• Inadequate immobilization, leading to displacement of fracture fragments 2
• Failure to recognize signs requiring surgical intervention, such as significant displacement or joint involvement 2, 3