What is the initial management for a mildly displaced tuft fracture?

Management of Mildly Displaced Tuft Fractures

The initial management for a mildly displaced tuft fracture should be conservative treatment with protective splinting and appropriate pain control, as these fractures typically heal well without surgical intervention.

Initial Assessment and Treatment

• Tuft fractures are fractures of the distal portion of the distal phalanx and are often minimally displaced 1
• Conservative management is the mainstay of treatment for mildly displaced tuft fractures, similar to other non-displaced or minimally displaced fractures 2
• Pain control should be initiated promptly, as fractures are painful particularly on movement 3
• Simple analgesics such as paracetamol should be prescribed on a regular basis unless contraindicated 3
• Opioids should be used with caution, especially in patients with potential renal dysfunction, and non-steroidal anti-inflammatory drugs are relatively contraindicated in many patients 3

Immobilization Techniques

• Protective splinting of the affected digit is recommended to provide stability and pain relief 2
• The splint should immobilize the distal interphalangeal joint while allowing proximal interphalangeal joint motion to prevent stiffness 2
• Immobilization is typically maintained for 3-4 weeks until clinical healing is evident 2

Special Considerations

• Most tuft fractures heal well with conservative management, but some unique fracture patterns with significant displacement may be irreducible by closed means 1
• In rare cases where fragments are significantly displaced into the pulp of the finger with entrapment in the fibrous septa, surgical intervention may be necessary 1
• Non-union is uncommon in tuft fractures but can occur in more proximal fractures of the distal phalanx shaft, which may require surgical intervention with Kirschner wire fixation 4

Rehabilitation

• Early rehabilitation should be initiated after the acute pain phase has subsided, typically 1-2 weeks after injury 5
• Rehabilitation should include:
  • Physical analgesic therapy 5
  • Techniques for recovering range of motion 5
  • Strengthening exercises as healing progresses 5
  • Proprioceptive stabilization exercises 5

Follow-up Care

• Regular follow-up is recommended to ensure proper healing and to adjust treatment if necessary 2
• Patients should be advised to return for re-evaluation if symptoms worsen or do not improve as expected 3
• Full recovery may take several weeks, but most patients can expect good functional outcomes with appropriate conservative management 5

Pitfalls to Avoid

• Avoid prolonged immobilization beyond 3-4 weeks as this can lead to joint stiffness and delayed functional recovery 5
• Do not ignore persistent pain or functional limitation, as this may indicate complications such as malunion or rare cases of non-union 4
• Be aware that some tuft fractures may have associated nail bed injuries or soft tissue damage that require separate management 1