From the Guidelines
The management of a fracture of the left 5th (D5) proximal phalanx typically involves simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is based on the principles outlined in the American College of Foot and Ankle Surgeons' guidelines, as reported in the American Family Physician journal 1. The key to successful management is to provide stability to the affected area while minimizing disruption to the patient's daily activities.
Key Considerations
- The diagnosis of a fracture of the left 5th proximal phalanx is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1.
- Immobilization is the preferred treatment for small, nonarticular, or minimally displaced fractures.
- The goal of treatment is to promote healing while maintaining function and preventing complications.
Treatment Approach
- Immobilization can be achieved through buddy taping to the adjacent fourth finger for 3-4 weeks, allowing for knuckle movement while restricting lateral motion.
- Pain control can be managed with acetaminophen 650mg every 6 hours or ibuprofen 400-600mg every 6-8 hours as needed for the first few days.
- Ice application and elevation above heart level can help reduce swelling.
- Physical therapy focusing on range of motion exercises should begin after the immobilization period to prevent stiffness.
Follow-up and Monitoring
- Patients should follow up within 1-2 weeks for X-ray evaluation to ensure proper alignment during healing.
- Regular monitoring is crucial to detect any potential complications or displacement of the fracture, which may require reduction or surgical fixation 1.
From the Research
Management of Fracture of the Left 5th (D5) Proximal Phalanx
The management of a fracture of the left 5th (D5) proximal phalanx depends on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction 2.
- Treatment Options: A wide array of treatment options exists for the variation in fracture patterns observed, including:
- Kirschner wires and screw-and-plate fixation for unstable fractures 2
- Early closed reduction for unicondylar fractures of the head of the proximal phalanx 2
- Plate fixation for bicondylar proximal phalanx fractures and comminuted proximal phalanx fractures 2
- Lag screws for spiral long oblique phalanx shaft fractures and metacarpal head fractures 2
- Intrinsic plus splint for stable short oblique transverse shaft fractures 2
- Conservative Management: Conservative management with buddy taping and immediate mobilisation can be effective for base fractures of the fifth proximal phalanx, with high overall satisfaction and minimal complications 3.
- Dynamic Treatment: Dynamic treatment of fractures of the proximal phalanx can achieve bony healing and free mobility at the same time, with active exercises in the proximal and distal interphalangeal joints preventing limitations of mobility and the subsequent occurrence of rotational and axial deformities 4.
- Specific Considerations: Dorsally angulated proximal phalanx fractures can be managed conservatively using a reversed dynamic or static finger extension splint, such as Roylan Sof-Stretch 5. Additionally, deep flexor tendon entrapment is a potential complication of diaphyseal fractures of the proximal phalanx, highlighting the importance of having a high index of suspicion to detect this situation 6.