What is the recommended treatment for a non-displaced extra-articular oblique fracture of the proximal phalanx of the fifth toe?

Treatment for Non-displaced Extra-articular Oblique Fracture of the Proximal Phalanx of the Fifth Toe

The recommended treatment for a non-displaced extra-articular oblique fracture of the proximal phalanx of the fifth toe is buddy taping to the adjacent fourth toe with immediate mobilization. 1

Initial Management

• Confirm the fracture is truly non-displaced with appropriate radiographic imaging 1
• Buddy taping involves securing the injured fifth toe to the adjacent fourth toe using medical tape or specialized toe sleeves 1
• This technique provides sufficient stability while allowing for functional movement 1

Treatment Protocol

• Apply buddy taping after initial assessment 1
• Allow immediate weight-bearing and mobilization as tolerated 1
• Buddy taping should be maintained for approximately 3-4 weeks 1
• Patient should be instructed on proper tape application and hygiene to prevent skin maceration 2

Expected Outcomes

• High overall satisfaction with conservative management 1
• Most patients regain full flexion of the affected toe 1
• Minimal pain at rest or during activities 1
• Low risk of malrotation that would require surgical intervention 1

Follow-up Care

• Clinical reassessment at 10-14 days to ensure proper alignment is maintained 3
• Final assessment at 4-6 weeks to confirm healing 3

Rationale for Conservative Management

• Non-displaced phalangeal fractures generally heal well with conservative treatment 2
• Surgical intervention is typically reserved for unstable fractures, articular incongruity, or significant displacement 2, 4
• Conservative functional treatment achieves bony healing while maintaining mobility simultaneously 3
• The fifth toe is not a primary weight-bearing structure, making conservative management appropriate 1

Common Pitfalls to Avoid

• Unnecessary immobilization can lead to joint stiffness and prolonged recovery 3
• Failure to recognize subsequent displacement during follow-up (though this is rare with proper buddy taping) 1
• Overlooking proper patient education on buddy tape application and maintenance 2

Special Considerations

• If pain persists or worsens, reassessment is warranted to rule out displacement 2
• For patients with diabetes or peripheral vascular disease, more frequent skin checks are necessary to prevent complications 2