What is the treatment for a minimally dorsally impacted subacute healing fracture at the base of the proximal phalanx of the left fifth finger?

Treatment of Minimally Dorsally Impacted Subacute Healing Fracture at the Base of the Proximal Phalanx of Left Fifth Finger

For a minimally dorsally impacted subacute healing fracture at the base of the proximal phalanx of the left fifth finger, conservative management with buddy taping to the adjacent fourth digit and immediate mobilization is the recommended treatment approach. 1

Initial Assessment and Imaging

• Radiography is essential as the initial imaging modality for suspected hand and wrist trauma, with a standard 3-view examination (PA, lateral, and oblique) to properly visualize the fracture 2
• An additional internally rotated oblique projection may increase diagnostic yield for phalangeal fractures 2
• Radiographs should assess displacement, angulation, and articular involvement to guide treatment decisions 3

Treatment Approach

Conservative Management (Recommended)

• Buddy taping of the fifth digit to the fourth digit with immediate mobilization is highly effective for base fractures of the fifth proximal phalanx 1
• This approach focuses on function rather than exact anatomical reduction, resulting in high patient satisfaction and excellent functional outcomes 1
• Conservative management is appropriate for:
  • Fractures with angulation <25° in the sagittal plane or <10° in the coronal plane after closed reduction 4
  • Fractures without uncorrectable finger rotation 4
  • Minimally displaced fractures (<2-3mm) 3

Alternative Conservative Options

• Dorsal plaster slab immobilization for 3 weeks may be used, even for unstable fracture patterns, with 91% of cases maintaining acceptable reduction (less than 15° of angulation) 5
• Functional treatment using a dorsopalmar plaster splint with the wrist in 30° dorsiflexion and metacarpophalangeal joints in 70-90° flexion (intrinsic plus position) can achieve bony healing while maintaining joint mobility 6

Expected Outcomes

• High overall patient satisfaction with conservative management 1
• Full flexion recovery in most patients (>95%) 1
• Minimal pain at rest or during activities 1
• Low risk of malrotation (approximately 6% of cases) that rarely requires surgical intervention 1
• No cases of nonunion or delayed union with buddy taping approach 1

Follow-up Protocol

• Radiographic follow-up at 10-14 days to ensure fracture position is maintained 3
• Clinical assessment of finger range of motion and pain levels during the healing process 1
• Average follow-up period of 7 weeks is typically sufficient to confirm healing and functional recovery 1, 5

Important Caveats and Pitfalls

• Surgical intervention should be considered only if:
  • Fracture displacement exceeds 3mm 3
  • More than one-third of the articular surface is involved 3
  • Conservative treatment fails to provide pain relief or restore function 3
  • Unacceptable reduction is observed during follow-up (occurs in approximately 9% of cases) 5
• Careful monitoring for malrotation is essential, as this complication can occur in a small percentage of cases 1
• Post-treatment monitoring should be adapted to the patient's individual needs, with particular attention to pain relief and restoration of function 3