What is the initial treatment for a nondisplaced intra-articular fracture of the proximal phalanx of the great toe with a burning sensation at the tip of the nail?

Initial Treatment for Nondisplaced Intra-articular Fracture of Proximal Phalanx of Great Toe with Burning Sensation

The initial treatment for a nondisplaced intra-articular fracture of the proximal phalanx of the great toe with a burning sensation at the tip of the nail should be immobilization with a splint or removable walker boot, along with appropriate pain management and neurological evaluation for the burning sensation. 1

Fracture Management

Initial Assessment and Immobilization

• Splinting of the fractured toe is useful to reduce pain, prevent further injury, and facilitate safe transport to a medical facility 1
• For nondisplaced intra-articular fractures of the proximal phalanx, immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1
• The splint should be applied in a way that accommodates any foot deformity safely and provides pressure redistribution to prevent subsequent complications 1

Pain Management

• NSAIDs can be used for pain control in the initial treatment phase 1
• Regular acetaminophen with cautious use of opioids may be necessary, especially if pain is severe 2
• Avoid local corticosteroid injections near the fracture site as they may impair healing 1

Neurological Symptoms Management

Evaluation of Burning Sensation

• The burning sensation at the tip of the nail suggests possible neurological involvement that requires careful evaluation 1
• If neurologic pain is suspected, consider referral for diagnostic testing such as electromyography, nerve conduction velocity studies, or MRI 1
• The burning sensation may indicate nerve irritation from the fracture or associated soft tissue injury 1

Treatment Approach for Neurological Symptoms

• Protect the affected area from further trauma by appropriate immobilization 1
• Consider covering any open wounds with clean dressings to prevent infection, especially if the burning sensation is associated with skin damage 1
• Monitor for signs of poor perfusion (blue, purple, or pale extremity), which would require immediate medical attention 1

Follow-up Care

Monitoring and Progression

• Regular follow-up is essential to monitor fracture healing and neurological symptoms 3
• Fracture healing typically occurs within 6-8 weeks for toe fractures 4
• If symptoms do not improve within 6-8 weeks, consider referral to a podiatric foot and ankle surgeon for further evaluation 1

Indications for Surgical Intervention

• Surgery is generally not indicated for nondisplaced intra-articular fractures of the proximal phalanx of the great toe unless there is subsequent displacement or failure to heal 4
• Surgical intervention carries a high complication rate, although most patients ultimately achieve good functional outcomes 3
• Open reduction with internal fixation may be considered if the fracture becomes displaced during treatment or if conservative management fails 4

Potential Complications and Pitfalls

Warning Signs

• Watch for signs of infection including increased pain, redness, warmth, or drainage 1
• Monitor for displacement of the fracture during the healing process, which may require reassessment of the treatment plan 3
• Be alert for worsening neurological symptoms, which may indicate nerve compression requiring more aggressive intervention 1

Avoiding Common Pitfalls

• Do not underestimate the importance of proper immobilization - inadequate immobilization can lead to displacement and poor healing 1
• Avoid weight-bearing on the affected foot during the initial healing phase to prevent displacement of the fracture 1
• Do not miss associated nail bed injuries or open fractures, which require more aggressive management including possible surgical debridement 5, 6