How to treat a non-displaced fracture at the base of the distal phalanx of the left index finger that extends to the articular surface?

Treatment of Non-Displaced Distal Phalanx Fracture with Articular Extension

For a non-displaced fracture at the base of the distal phalanx of the left index finger that extends to the articular surface, removable splinting for 3-4 weeks is the recommended treatment. 1

Assessment and Initial Management

• Standard 3-view radiographic examination should be performed to confirm proper alignment and fracture pattern before initiating treatment 2
• Fractures are classified as significantly displaced when there is >3mm displacement or >10° dorsal tilt 1
• The presence of intraarticular extension requires careful evaluation, but non-displaced intraarticular fractures can typically be managed conservatively 1, 3

Treatment Plan

• For non-displaced intraarticular fractures of the distal phalanx:

  • Apply a removable splint that immobilizes the distal interphalangeal (DIP) joint while allowing proximal interphalangeal (PIP) joint motion 1
  • Duration of immobilization should typically last 3-4 weeks 1
  • Active finger motion exercises for non-immobilized joints should be performed following diagnosis to prevent stiffness 1

• Surgical intervention is only indicated if:

  • Fracture displacement is >3mm 1, 4
  • Dorsal tilt exceeds 10° 1
  • Significant intraarticular displacement is present 1, 5

Follow-up Protocol

• Radiographic follow-up should be performed at approximately 3 weeks post-immobilization to assess healing 1
• Additional radiographic evaluation should be done at the time of immobilization removal to confirm adequate healing 1
• Early follow-up is critical as delayed treatment (>12.5 days) of intraarticular fractures increases the risk of DIP joint subluxation 6

Potential Complications

• Immobilization-related adverse events occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 1
• Joint stiffness is a common complication without proper treatment and rehabilitation 1, 7
• Intraarticular fractures have a risk of developing post-traumatic arthritis if not properly managed 7

Special Considerations

• While some historical sources suggest that most distal phalanx fractures require minimal intervention 8, more recent evidence emphasizes the importance of proper immobilization for intraarticular fractures 1, 6
• If the fracture involves more than 48% of the articular surface, there is an increased risk of DIP joint subluxation, which may warrant closer monitoring 6
• Avoid prolonged immobilization of uninvolved joints to prevent unnecessary stiffness 1, 7