From the Research
Management of Non-Displaced Distal First Phalanx Fracture of the Foot
- The majority of distal phalanx fractures of the toes are treated conservatively with good outcome 1
- Non-surgical management is the preferred treatment of stable, extra-articular fractures of the proximal and middle phalanx, most distal phalanx fractures, and, rarely, non-displaced intra-articular fractures in elite athletes 2
- Conservative management is often chosen for non-displaced distal phalanx fractures, with the goal of restoring function while limiting the risk of complications 3
- The treatment of phalangeal fractures depends on the characteristics of the fracture, condition of the soft tissue envelope, associated injuries, patient functional requirements, and surgeon familiarity and comfort with various techniques 4
Treatment Options
- Nonoperative means are often used to treat phalangeal fractures, with surgery considered for unstable injuries, articular incongruity, concomitant soft tissue damage, or other situations in which restoration of anatomy and preservation of function are achieved only via operative stabilization 4
- Surgical fixation with concomitant inter-phalangeal joint (IPJ) arthrodesis may be used to treat symptomatic non-union of fracture of the distal phalanx 1
- Open reduction with internal fixation with plate fixation is most often chosen for unstable phalangeal shaft fractures in high-demand athletes to provide rigid internal fixation and allow immediate range of motion and more rapid return to sport 2
Return to Sport
- Evidence-based guidance on return to sport following toe phalanx fractures is limited, but the majority of sport-related toe phalanx fractures (acute and stress) are managed conservatively with overall satisfactory return to sport rates and return times 5
- For acute fractures, surgical management is indicated for displaced, intra-articular (physeal) fractures, which offers satisfactory return to sport rates and return times 5
- For stress fractures, surgical management is indicated for cases with delayed diagnosis and established non-union at presentation, or with significant underlying deformity: both can expect satisfactory return to sport rates and return times 5