Splinting Treatment for Tuft Fractures of the Fourth and Fifth Fingers
For tuft fractures of the fourth and fifth fingers, protective splinting in the position found with a padded splint that allows for active finger motion is the recommended treatment approach. 1, 2
Initial Management
- Tuft fractures are typically stable injuries that can be managed conservatively with splinting 2, 3
- Stabilize the extremity with a splint in the position found, without attempting to straighten the injured finger 1
- The splint should be padded to cushion the injury and prevent further damage 1
- Cover any open wounds with a clean dressing before splinting 1
Splinting Technique
- For distal phalanx tuft fractures, immobilize the distal interphalangeal (DIP) joint for 4-6 weeks 3
- Use a rigid finger splint that protects the fracture site while allowing for motion of unaffected joints 1, 2
- Ensure the splint is comfortably tight but not constrictive - it should allow a finger to be slipped under it 1
- Buddy taping to an adjacent uninjured finger may provide additional support and stability 3
Active Motion Protocol
- Instruct patients to perform active finger motion exercises following diagnosis to prevent stiffness 1
- Regular movement of the fingers through a complete range of motion helps minimize complications 1
- Finger motion does not adversely affect adequately stabilized fractures and is extremely cost-effective 1
- Hand stiffness is one of the most functionally disabling adverse effects of finger injuries and should be prevented 1
Cold Application
- Apply cold to the injury site to decrease hemorrhage, edema, pain, and disability 1
- Use a plastic bag or damp cloth filled with a mixture of ice and water (better than ice alone) 1
- Limit cold application to periods of 20 minutes, or 10 minutes if uncomfortable 1
- Place a barrier, such as a thin towel, between the cold container and the skin 1
Follow-up Care
- Radiographic follow-up is recommended at approximately 3 weeks 4
- Most tuft fractures heal well with conservative management 2
- Monitor for signs of complications such as infection, malunion, or persistent pain 2, 3
Special Considerations
- If there is significant displacement (>3mm) or intra-articular involvement, surgical management may be indicated 4
- Non-union in distal phalanx fractures is rare but can occur and may require surgical intervention if symptomatic 5
- If the injured extremity appears blue or extremely pale, seek immediate medical attention as this could indicate a vascular emergency 1