From the Guidelines
Surgery is the usual treatment for a fractured phalanx, but simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. When considering treatment for a fractured phalanx, several factors come into play, including the size and location of the fracture, as well as the patient's overall health and activity level 1. The goal of treatment is to promote proper healing, minimize morbidity, and maintain quality of life. Some key considerations include:
- Immobilization with a splint for 3-4 weeks to allow the bone to heal
- Pain management with over-the-counter medications like acetaminophen or ibuprofen
- Ice and elevation to reduce swelling
- Potential need for physical therapy to restore range of motion and strength after healing
- Surgery may be necessary in cases where the fracture is large, affects joint stability, or causes joint misalignment 1. It's essential to monitor for signs of complications, such as persistent or worsening pain, increasing swelling, numbness, or color changes, which may require medical reevaluation and alternative management 1.
From the Research
Treatment Options for Phalangeal Fractures
- Most phalangeal fractures can be treated successfully with nonoperative means 2
- Surgery is considered to treat unstable injuries, articular incongruity, concomitant soft tissue damage, or other situations in which restoration of anatomy and preservation of function are achieved only via operative stabilization 2
- Dynamic treatment, which includes the use of a custom-molded 2-component thermoplastic splint, can be used for nonoperative treatment or after operative treatment of proximal phalangeal fractures 3
- The aim of dynamic treatment is to achieve bone healing and recovery of motion at the same time, rather than in succession 3, 4
Specific Treatment Methods
- A splint system that allows motion of the proximal and distal interphalangeal joints can be used for dynamic treatment of proximal phalangeal fractures 3
- A dorsopalmar plaster splint and a finger splint can be used to immobilize the wrist and metacarpophalangeal joints, while allowing motion of the interphalangeal joints 4
- An isometric traction splint can be used to treat fractures of the proximal phalanx of long fingers, but may not be suitable for compression type fractures 5
- The Iselin splint can be used for conservative treatment of phalangeal fractures, with special attention focused on defective position in axis and rotation of the fractured phalanx 6
Indications for Surgery
- Open fractures, dislocated non-reponible fractures, fractures involving the joint, and condylar fractures are indications for operative treatment of phalangeal fractures 2, 6
- Patient compliance, type of fracture, and localization of the fracture are also factors to consider when deciding on operative treatment 6