How long should a minimally dorsally impacted subacute healing fracture at the base of the proximal phalanx be buddy taped?

Duration of Buddy Taping for Minimally Dorsally Impacted Subacute Healing Fracture at the Base of the Proximal Phalanx

Buddy taping should be continued for 4-6 weeks for a minimally dorsally impacted subacute healing fracture at the base of the proximal phalanx, with immediate mobilization of the finger to optimize functional outcomes. 1

Treatment Approach for Proximal Phalanx Base Fractures

• Minimally displaced base fractures of the proximal phalanx can be effectively treated with conservative management using buddy taping to the adjacent digit (typically the ring finger for a fifth digit fracture) 1
• Buddy taping provides sufficient stabilization while allowing immediate mobilization, which helps prevent stiffness and promotes better functional outcomes 1, 2
• The focus of treatment should be on functional recovery rather than perfect anatomical reduction, especially for minimally displaced fractures 1

Duration of Immobilization

• For proximal phalanx base fractures, buddy taping should be maintained for 4-6 weeks to provide adequate support during the healing process 1, 3
• Functional support for 4-6 weeks is preferred over rigid immobilization, as it allows for better outcomes in terms of mobility and function 4
• Complete fracture healing typically occurs within 6-8 weeks, with most fractures showing significant healing by 4 weeks 2, 5

Mobilization Protocol

• Early active range of motion exercises should begin immediately while the buddy taping is in place 1, 2
• The metacarpophalangeal joint should be positioned in slight flexion (70-90 degrees) to optimize fracture stability through the intrinsic plus position 2
• Active exercises of the proximal and distal interphalangeal joints help prevent limitations in mobility and subsequent occurrence of rotational and axial deformities 2

Monitoring and Follow-up

• Clinical and radiographic assessments should be performed at approximately 2 weeks and 4-6 weeks post-injury to evaluate healing progress and ensure proper alignment 3, 5
• Most proximal phalanx fractures show radiographic healing by 8 weeks, with many showing significant healing by 4 weeks 2, 5
• If secondary displacement occurs (which happens in approximately 11% of cases), reassessment and potential adjustment of the treatment plan may be necessary 3

Expected Outcomes

• With buddy taping and early mobilization, most patients (86%) can achieve full range of motion by the end of the treatment period 2
• High overall satisfaction rates are reported with conservative management using buddy taping for proximal phalanx base fractures 1
• Only minimal pain at rest or during activities is typically reported after proper healing 1
• Malrotation is rare (noted in approximately 5-6% of cases) and rarely requires surgical intervention 1

Potential Complications to Monitor

• Extension lag in the proximal interphalangeal joint may occur in some cases (up to 14% of patients) but is usually limited to less than 20 degrees 2
• Limitation of flexion is rare but may occur in a small percentage of cases 2
• Non-union or delayed union is extremely uncommon with proper buddy taping and mobilization protocol 1, 2

Special Considerations

• For pediatric patients with proximal phalanx base fractures, immobilization for 3-4 weeks is typically sufficient 5
• Surgical intervention is rarely required for minimally displaced fractures and should be reserved for unstable fractures with significant displacement or rotation 6, 5
• The functional outcomes of conservative treatment with buddy taping are generally excellent, making it the preferred approach for minimally displaced fractures 1, 3