Treatment of Distal Non-Articular, Non-Comminuted Middle Phalanx Fracture in 13-Year-Old Male
For this stable, non-displaced middle phalanx fracture in a 13-year-old, treat with removable splinting for 3-4 weeks combined with immediate active finger motion exercises to prevent stiffness.
Initial Management Approach
Removable splinting is the appropriate treatment for this minimally displaced, non-comminuted fracture, with immobilization lasting 3-4 weeks 1. This approach is supported by AAOS guidelines for similar stable pediatric fractures 2.
Key Treatment Components:
- Immediate active finger motion exercises should be started following diagnosis to prevent joint stiffness, which is the most functionally disabling complication of phalangeal fractures 1, 2
- Nondisplaced phalanx fractures in pediatric patients are managed with splint immobilization, as this population (age 10-14 years) has the highest incidence of phalangeal fractures 3
- Finger motion exercises do not adversely affect adequately stabilized fractures in terms of reduction or healing 2
Follow-Up Protocol
Radiographic evaluation should occur at specific intervals to ensure proper healing:
- Initial radiographs to confirm the fracture pattern and lack of displacement 1
- 3-week follow-up imaging to assess healing progress and rule out delayed displacement 1, 2
- Imaging at time of immobilization removal to confirm adequate healing before discontinuing splinting 1, 2
Indications That Would Require Surgical Management
Monitor for features that would change management to operative intervention:
- Displacement >3mm would necessitate surgical fixation 1, 4
- Dorsal tilt >10° is an AAOS indication for surgical management 1, 4
- Intra-articular involvement requires operative treatment 1, 2
- Unstable or displaced fractures in pediatric patients require closed reduction and percutaneous pinning 3
Critical Pitfalls to Avoid
- Prolonged immobilization beyond 4 weeks leads to stiffness and reduced function, which is particularly problematic in active adolescents 1
- Failure to initiate early finger motion results in joint stiffness, the most functionally disabling complication 1, 2
- Inadequate follow-up imaging may miss delayed displacement requiring intervention 1
- Immobilization-related complications occur in approximately 14.7% of cases, including skin irritation and muscle atrophy, so monitor the splint fit regularly 1, 4
Special Considerations for This Age Group
- At 13 years old, this patient is in the peak age range (10-14 years) for phalangeal fractures, often related to sports activities 3
- The unmineralized physis in this age group is biomechanically weaker than surrounding structures, but this distal middle phalanx location is extra-articular and non-physeal 3
- Stable, reduced phalanx fractures require close monitoring to ensure maintenance of reduction throughout the healing period 3