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 is recommended unless straightening is necessary for safe transport. 1
Initial Management
- Immobilize the fractured toe in the position found to reduce pain, prevent further injury, and facilitate transport to a medical facility 1
- Cover any open wounds associated with the fracture with a clean dressing to reduce risk of contamination and infection 1
- If the fractured toe appears blue, purple, or pale, activate emergency medical services immediately as this indicates poor perfusion 1
- Do not attempt to straighten a deformed fracture unless necessary for safe transport 1
Splinting Technique
- Use a rigid splint that immobilizes the fracture site while allowing for motion of unaffected joints 2
- The splint should extend beyond the fracture site to include adjacent joints for stability 1
- For toe fractures, buddy taping to an adjacent uninjured toe can provide adequate support and immobilization 1
- Padding should be placed between the toes to prevent skin maceration 1
Special Considerations for Comminuted Fractures
- Comminuted fractures involve multiple bone fragments and may require more robust immobilization than simple fractures 3
- For significantly displaced or unstable comminuted fractures, referral for potential surgical management may be necessary 3
- CT imaging may be needed to fully assess the extent of comminution and intra-articular involvement 1
- MRI can be useful if there is concern for associated soft tissue injuries 1
Duration of Immobilization
- Immobilization should be maintained until clinical and radiographic evidence of healing 2
- Radiographic follow-up is typically recommended at approximately 3 weeks 2
- Total immobilization time varies based on fracture severity, but typically ranges from 3-6 weeks 2
Rehabilitation Considerations
- Early motion of unaffected joints should be encouraged to prevent stiffness 2
- Weight-bearing status should be determined based on fracture stability and healing progress 1
- For stable fractures, weight-bearing as tolerated may be appropriate 1
Pitfalls and Caveats
- Overtightening a compression wrap can compromise circulation 1
- Failure to immobilize a comminuted fracture adequately may lead to malunion or nonunion 3
- Intra-articular fractures of the proximal phalanx carry higher risk for post-traumatic arthritis and may require more specialized care 4
- Compression-type fractures may benefit from different immobilization strategies than distraction-type injuries 5
By following these guidelines for splinting a comminuted fracture of the proximal phalanx of the big toe, you can help ensure proper alignment during healing while minimizing pain and preventing further injury.