What is the treatment for a non-displaced fracture of the distal proximal phalanx?

Treatment of Non-Displaced Fracture of the Distal Proximal Phalanx

Non-displaced fractures of the distal proximal phalanx should be treated with removable splinting for 3-4 weeks with radiographic follow-up at approximately 3 weeks to confirm adequate healing. 1

Assessment and Initial Management

• Non-displaced fractures (less than 3mm displacement) of the proximal phalanx can be effectively treated with conservative management using removable splinting 1
• Radiographic evaluation should be performed initially to confirm diagnosis and fracture pattern 1
• The splint should be custom-molded to allow for proper immobilization while maintaining function of unaffected joints 2

Splinting Technique

• A custom-molded 2-component thermoplastic splint is recommended that allows motion of the proximal and distal interphalangeal joints while stabilizing the fracture site 2
• The wrist should be positioned in approximately 30 degrees of dorsiflexion with the metacarpophalangeal joints flexed 70-90 degrees (intrinsic plus position) to provide optimal fracture stabilization 3
• This position creates tension in the extensor aponeurosis which covers two-thirds of the proximal phalanx, providing firm splinting of the fracture 3

Duration and Follow-up

• Immobilization typically lasts 3-4 weeks 1
• Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 4, 1
• Active finger motion exercises should be performed following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects 4, 1

When to Consider Surgical Management

• If there is significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management should be considered instead of conservative treatment 1
• Surgical options for displaced fractures include:
  • Multiple Kirschner wire fixation, which has been shown to provide the best final joint motion for unicondylar fractures 5
  • Screw fixation for spiral or oblique fractures 6
  • Plate fixation for comminuted fractures 6

Potential Complications and Prevention

• Immobilization-related adverse events occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 1
• Joint stiffness is a significant potential complication that can be minimized through:
  • Early active finger motion exercises of uninvolved joints 4, 1
  • Proper splint design that allows motion of the proximal and distal interphalangeal joints 2
  • Avoiding excessive immobilization periods 3

Expected Outcomes

• With proper treatment, fracture consolidation can be expected in virtually all cases of non-displaced proximal phalanx fractures 2, 3
• Full active motion can typically be achieved simultaneously with bone healing within 6 weeks in most patients 2
• The goal of functional treatment is to achieve both bony healing and free mobility concurrently rather than sequentially 3