What is the treatment plan for a non-displaced first proximal phalanx fracture in a pediatric patient?

Treatment Plan for Non-displaced First Proximal Phalanx Fracture in Pediatric Patients

The recommended treatment for a non-displaced first proximal phalanx fracture in a pediatric patient is immobilization with a posterior splint for 3 weeks, followed by clinical assessment to determine if continued immobilization is necessary. 1

Initial Management

• Non-displaced proximal phalanx fractures in children should be treated conservatively with immobilization 2
• Posterior splinting is preferred over collar and cuff immobilization as it provides better pain relief in the first 2 weeks after injury 3
• The splint should properly immobilize the affected digit while maintaining proper alignment 4

Duration of Immobilization

• Recent evidence supports a 3-week immobilization protocol for proximal phalanx fractures that present as clinically healed at the 3-week assessment 1
• Traditional protocols often recommend 5 weeks of immobilization, but children typically show clinical healing by 3 weeks 1
• Clinical assessment at 3 weeks should evaluate:
  • Absence of pain with gentle palpation at fracture site
  • Absence of pain with gentle passive range of motion
  • Radiographic evidence of healing 4

Splint vs. Cast Options

• Both removable splints and casts show similar radiologic and clinical outcomes for pediatric phalangeal fractures 5
• Splinting offers advantages of increased comfort and hygiene compared to casting 5
• Dynamic protective splinting techniques using fiberglass material can provide adequate protection while allowing earlier return to function 4

Follow-up and Monitoring

• Regular radiographic assessment is necessary to ensure maintenance of fracture reduction 2
• Follow-up appointments should be scheduled at:
  • 1 week post-injury to check splint fit and fracture alignment
  • 3 weeks post-injury to assess clinical healing and potentially discontinue immobilization 1
  • 5 weeks post-injury if continued immobilization was required 1

Indications for Surgical Management

• Surgery is indicated only if the fracture is:
  • Unstable
  • Significantly displaced
  • Shows rotational deformity or coronal malalignment 2
• For fractures requiring surgery, closed reduction with percutaneous pinning is the preferred technique 6

Expected Outcomes

• With appropriate conservative management, pediatric patients with non-displaced proximal phalanx fractures typically achieve:
  • Full range of motion
  • Complete fracture healing
  • No clinically apparent bony deformities 4
• Most patients show good functional results within 2 weeks of splint removal 4

Potential Complications

• Loss of reduction - requires close monitoring during the immobilization period 2
• Stiffness - can be minimized by appropriate duration of immobilization and early functional rehabilitation when clinically appropriate 1, 4
• Malunion - rare with proper initial alignment and immobilization 2