What is the treatment for an avulsion fracture of the 4th digit (fourth finger) of the left hand?

Treatment of Avulsion Fracture of the 4th Digit Left Hand

For an avulsion fracture of the 4th digit of the left hand, treatment with a removable splint for 3-4 weeks is recommended, allowing for immobilization of the affected joint while permitting motion in unaffected joints. 1, 2

Initial Assessment and Management

• Obtain standard 3-view radiographic examination (anteroposterior, lateral, and oblique) to confirm proper alignment and fracture pattern before initiating treatment 2, 3
• Evaluate for displacement (significant if >3mm displacement or >10° angulation), which would require more aggressive management 1, 2
• Assess for any open wounds associated with the fracture, which should be covered with a clean dressing to lower the risk for contamination and infection 4
• Check for signs of vascular compromise - if the digit appears blue, purple, or pale, immediate medical attention is required 4

Treatment Protocol

• For non-displaced avulsion fractures of the 4th digit:

  • Apply a removable splint that immobilizes only the affected joint while allowing motion in unaffected joints 1, 2
  • Duration of immobilization should typically last 3-4 weeks 2, 3
  • Splinting is useful to reduce pain, prevent further injury, and facilitate healing 4

• For specific types of avulsion fractures:

  • Dorsal avulsion fractures (mallet finger) require strict splint immobilization for 8 weeks 3
  • Flexor digitorum profundus avulsion fractures usually require surgical intervention 3, 5
  • Palmar plate avulsion injuries can be immobilized in extension (0 degrees) for 7-10 days, followed by buddy taping and active range of motion 6

Follow-up Protocol

• Radiographic follow-up should be performed at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1, 2
• Active finger motion exercises for non-immobilized joints should be performed following diagnosis to prevent stiffness 1, 2
• After splint removal, buddy taping (taping the injured finger to an adjacent healthy finger) may be beneficial for additional protection during the rehabilitation phase 3, 6

Potential Complications

• Monitor for immobilization-related adverse events which occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 1, 2
• Joint stiffness is a common complication without proper treatment and rehabilitation 2, 7
• If the avulsion fracture involves an articular surface, there is risk of developing post-traumatic arthritis if not properly managed 2

When to Consider Referral

• If there is significant displacement (>3mm), angulation (>10°), or intra-articular involvement 1, 2
• For flexor digitorum profundus avulsion injuries (jersey finger), which typically require surgical reattachment within 10 days of injury 5
• If the fracture is associated with joint dislocation or significant collateral ligament injury 6
• For fractures with open wounds and severe bleeding that cannot be controlled with direct pressure 4