What is the treatment for a middle phalanx fracture?

Treatment of Middle Phalanx Fractures

The treatment of middle phalanx fractures should be guided by fracture characteristics, with most stable fractures managed non-operatively through immobilization, while unstable, displaced, or intra-articular fractures typically require surgical intervention. 1

Assessment and Classification

• Middle phalanx fractures can be classified into five types: single palmar fragment, single dorsal fragment, two main fragments, non-articular (including epiphyseal separations in children), and all others 2
• Fracture stability, displacement, articular involvement, and soft tissue condition are critical factors in determining treatment approach 1
• Careful assessment for obvious deformity, swelling, bruising, severe pain with movement, or inability to move the affected digit is essential 3

Non-operative Management

• Most stable, non-displaced, extra-articular middle phalanx fractures can be successfully treated with non-operative means 1, 4
• Rigid immobilization is preferred over removable splints for displaced fractures requiring non-surgical treatment 5
• For immobilization of acute fractures, a sling is generally preferred over figure-of-eight bracing 5
• Appropriate pain management, activity modification, and in some cases bracing may be sufficient for stable fractures 5

Surgical Indications

• Surgery is indicated for:
  • Unstable fractures 2, 4
  • Articular incongruity 2
  • Displaced fractures with significant deformity 1
  • Open fractures 3
  • Fractures with associated soft tissue injuries 1
  • Type-1 unstable avulsion fractures and type-2 avulsions at risk for buttonhole deformities 2

Surgical Options

• Open reduction with internal fixation using plate fixation is often preferred for unstable phalangeal shaft fractures, particularly in high-demand patients, as it provides rigid fixation and allows earlier range of motion 4
• Percutaneous pinning with Kirschner wires is an option for certain fracture patterns 3, 4
• Unicondylar fractures in athletes are commonly treated with percutaneous headless compression screws 4
• For comminuted fractures, interphalangeal traction systems utilizing capsuloligamentotaxis can be effective 6
• Intradigital traction devices can be used for fracture-dislocations of the middle phalanx at the proximal interphalangeal joint 7

Rehabilitation

• Early mobilization is a key principle in phalangeal fracture treatment to prevent stiffness and optimize functional outcomes 1
• Rehabilitation should include muscle strengthening exercises 3
• Long-term continuation of hand exercises is essential for recovery 3
• Patient education regarding pain management strategies and rehabilitation exercises is important 3

Complications and Follow-up

• Patients should be educated about signs of complications requiring medical attention 3
• If a fractured extremity appears blue, purple, or pale, immediate emergency medical care is necessary 3
• Long-term outcomes are generally good when treatment achieves good stability and articular congruity 2

Special Considerations

• Surgical techniques should aim for maximal strength with minimal dissection, particularly in athletes or high-demand patients 4
• Careful soft tissue handling during surgical intervention is crucial to preserve function 1
• Treatment approach may need to be adjusted based on patient's functional requirements and surgeon's expertise with various techniques 1