Management of Chip Fractures
The management of chip fractures should be conservative with immobilization for approximately 3 weeks, as this approach has proven successful with good clinical outcomes and healing within 6-8 weeks. 1
Diagnostic Approach
- Initial evaluation should include standard radiographs to assess fracture pattern, displacement, and articular congruity 2
- CT scanning may be necessary when radiographs are inconclusive, especially when using metal artifact reduction techniques to detect occult fractures 2
- MRI may be indicated for evaluation of associated soft tissue injuries and to assess for bone marrow edema patterns 3
Treatment Algorithm Based on Fracture Type
Non-displaced Chip Fractures
- Conservative treatment with immobilization for 3 weeks is the recommended approach 1
- No surgical intervention is typically indicated for chip fractures 1
- Follow-up imaging should be performed to ensure proper healing, with bone fragments typically healing within 6-8 weeks 1
Displaced Chip Fractures
- Most chip fractures can be treated non-operatively even with minimal displacement 1
- For significantly displaced fragments or those causing mechanical symptoms, surgical intervention may be considered 4
- Arthroscopic removal of chip fragments may be appropriate in select cases where the fragment causes mechanical symptoms or joint dysfunction 5
Post-Treatment Management
- Appropriate pain management should be implemented following immobilization 3
- Early mobilization after the immobilization period is important to restore function 3
- Rehabilitation program should include:
Special Considerations
- For open fractures with chip fragments:
- Antibiotic therapy should be initiated as soon as possible, preferably within 3 hours of injury 7
- Surgical debridement may be necessary, though timing within 12 hours does not appear to affect infection rates if antibiotics are administered 7
- Soft tissue management is critical and should be addressed concurrently with fracture management 7
Monitoring and Follow-up
- Clinical and radiographic follow-up should be performed to assess healing 1
- CT scan at 6 weeks may be useful in cases with doubtful union to measure fracture gap and determine if further intervention is needed 8
- For fractures showing delayed union (gap >2mm at 6 weeks), surgical fixation may be considered 8
Potential Complications
- Non-union is rare with appropriate conservative management of chip fractures 4
- Post-traumatic joint instability is uncommon with isolated chip fractures 1
- Avascular necrosis is unlikely due to good vascularization of most areas where chip fractures occur 1