Treatment for Second Proximal Phalangeal Avulsion Fracture
Primary surgical treatment with internal fixation is the recommended approach for displaced proximal phalangeal avulsion fractures of the second digit, as conservative treatment has shown high failure rates.
Assessment and Diagnosis
- Avulsion fractures of the proximal phalanx are painful injuries requiring prompt diagnosis through clinical assessment and imaging 1
- Radiographic confirmation should be obtained to assess displacement and fracture characteristics 1
Treatment Options
Surgical Management
- Internal fixation with a single lag screw through a palmar approach is highly effective for avulsion fractures at the base of proximal phalanges 2
- All conservatively treated fractures in one study failed to unite and subsequently required surgery, while primary surgical fixation achieved excellent results 2
- Surgical options depend on fragment size:
Post-Surgical Management
- Modern rehabilitation protocols favor early controlled mobilization rather than prolonged immobilization 3
- The evolution of post-surgical management has moved from:
- Extended immobilization (6 weeks in cast) to
- Shorter immobilization (4 weeks in cast) to
- Current best practice: immediate postoperative range of motion (40-70 degrees) with muscle-strengthening exercises in a functional brace 3
Conservative Management
- Conservative management has poor outcomes for proximal phalangeal avulsion fractures, with one study showing 100% failure rate requiring subsequent surgical intervention 2
- This differs from other avulsion fractures (such as pelvic and proximal femur avulsions) which can be successfully treated non-surgically 4
Special Considerations
- For palmar plate avulsion injuries of the proximal interphalangeal joint (different from base avulsions), extension splinting at zero degrees for 7-10 days followed by buddy taping and active range of motion has shown good results 5
- Early diagnosis is crucial as missed injuries may lead to complications requiring more complex interventions 6
Expected Outcomes
- With proper surgical fixation and early controlled mobilization, patients can expect excellent results with full range of motion achieved within 3 weeks 2
- Aggressive postoperative rehabilitation programs with functional bracing lead to satisfactory outcomes 3
Pitfalls to Avoid
- Avoid conservative management for displaced avulsion fractures of the proximal phalanx as this has high failure rates 2
- Avoid prolonged immobilization which may lead to stiffness and decreased range of motion 3
- Do not miss associated injuries such as tendon avulsions which may require additional treatment 6