What is the treatment for a proximal phalanges fracture?

Treatment for Proximal Phalanx Fractures

The treatment of choice for proximal phalanx fractures is dynamic treatment using a custom-molded thermoplastic splint that immobilizes the metacarpophalangeal (MCP) joint in flexion while allowing free movement of the interphalangeal joints, enabling simultaneous bone healing and recovery of motion. 1, 2

Initial Assessment and Management

• Patients with proximal phalanx fractures typically present with deformity, swelling, bruising, and loss of function 1
• Radiographic evaluation should include anteroposterior, lateral, and oblique views to identify fracture patterns and determine appropriate treatment 1
• Pain management is essential and should include appropriate analgesia while avoiding NSAIDs in patients with renal dysfunction 3
• Uncomplicated proximal phalanx fractures with minimal angulation (less than 10 degrees) can be treated with buddy splinting 1

Dynamic Treatment Approach

• Dynamic treatment utilizes the stabilizing effect of the zancolli complex-metacarpophalangeal retention apparatus to provide fracture stability while allowing interphalangeal joint motion 2

• The custom-molded thermoplastic splint consists of two components 4:

  • A dorsopalmar component that immobilizes the wrist in 30 degrees of dorsiflexion
  • A finger component that holds the MCP joint in 70-90 degrees of flexion (intrinsic plus position)

• This position creates tension in the extensor aponeurosis, which covers two-thirds of the proximal phalanx, providing firm splinting of the fracture 5

• The proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints remain free to move, allowing early mobilization 4, 6

Treatment Duration and Rehabilitation

• The dynamic splint should be maintained for at least 4 weeks, with the exact duration determined individually based on fracture healing 6
• Active exercises of the PIP and DIP joints should begin immediately to prevent stiffness and contractures 5
• The splint can be removed for wound care and radiographic evaluations as needed 4
• Supervised rehabilitation is crucial to gain full range of motion and prevent extension lag contractures 2

Expected Outcomes

• Studies show excellent to good results in 94% of patients using dynamic treatment 2
• Fracture consolidation can be achieved in all patients with proper treatment 4
• Full active motion recovery occurs simultaneously with bone healing in most patients by 6 weeks 4
• Poor outcomes (approximately 6%) are typically associated with older patient age and poor compliance with rehabilitation 6, 2

Indications for Surgical Referral

• Fractures with significant angulation (greater than 10 degrees), displacement, or malrotation often require reduction or surgical intervention 1
• Intra-articular fractures may still be managed with dynamic treatment following appropriate reduction 4
• Complex fracture patterns that cannot be adequately stabilized with dynamic treatment may require surgical fixation 1

Common Pitfalls and Considerations

• Inadequate flexion of the MCP joint in the splint may compromise fracture stability 5
• Patient non-compliance with the rehabilitation program is associated with poor outcomes 6, 2
• Delayed mobilization can lead to stiffness and contractures, particularly at the PIP joint 5
• Regular follow-up is essential to ensure proper fracture alignment and healing 3