Immobilization Duration for Distal Phalanx Tuft Fractures
Distal phalanx tuft fractures should be immobilized for 4-6 weeks with a protective splint. 1
Treatment Approach
- Uncomplicated distal phalanx tuft fractures, which typically result from crush injuries to the fingertip, require splinting of the distal interphalangeal (DIP) joint for 4-6 weeks 1
- Removable splints are appropriate for minimally displaced fractures, as recommended by the American Academy of Orthopaedic Surgeons (AAOS) 2
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 2, 3
Active Finger Motion During Immobilization
- Active finger motion exercises should be performed immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects 4, 2
- Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 4, 2
- Finger stiffness can be very difficult to treat after fracture healing, potentially requiring multiple therapy visits and possibly additional surgical intervention 4
Special Considerations
- If there is significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management may be indicated instead of conservative treatment 2, 3
- For displaced fractures, rigid immobilization (casting) is preferred over removable splints 2
- Monitor for potential complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 2, 3
Unstable Fractures
- Unstable distal phalanx fractures may require surgical intervention with K-wire fixation 5
- When surgical fixation is used, K-wires are typically removed after approximately 1 month 5
- The principles applied to shaft fractures of the middle and proximal phalanges also apply to the distal phalanx when considering surgical treatment 6
Post-Immobilization Care
- After the immobilization period, gradual return to activities is recommended to prevent re-injury 3
- A home exercise program should be prescribed for rehabilitation to restore full range of motion 3
- Consider adjuvant treatment with vitamin C for the prevention of disproportionate pain during the healing process 4, 3