Treatment of Distal Phalanx Tuft Fractures
For distal phalanx tuft fractures, treat with removable splinting of the distal interphalangeal (DIP) joint for 4-6 weeks, combined with immediate active finger motion exercises to prevent stiffness. 1, 2
Initial Management
Most tuft fractures result from crush injuries and require minimal specific fracture treatment, with primary focus on soft tissue care 3. The fracture itself rarely needs surgical intervention unless there is significant displacement (>3mm) or associated complications 1.
Conservative Treatment Protocol
- Immobilize the DIP joint with a removable splint for 4-6 weeks 2
- The American Academy of Orthopaedic Surgeons supports removable splinting for minimally displaced fractures, with typical immobilization duration of 3-4 weeks 1
- Begin active finger motion exercises immediately after diagnosis to prevent stiffness, which is one of the most functionally disabling complications 1
When to Consider Surgical Fixation
Surgical intervention is indicated when 1:
- Displacement exceeds 3mm
- Dorsal tilt exceeds 10°
- Intra-articular displacement is present
However, tuft fractures specifically are almost always managed conservatively since they are extra-articular and typically stable 3, 4.
Follow-Up Protocol
Obtain radiographic evaluation at 1:
- Initial presentation to confirm diagnosis and fracture pattern
- Approximately 3 weeks post-immobilization to assess healing
- Time of immobilization removal to confirm adequate healing
Critical Management Points
Finger motion exercises are essential and do not adversely affect adequately stabilized fractures 5. This intervention is cost-effective, requires no additional visits, and significantly impacts patient outcomes by preventing the most common complication—finger stiffness 5.
Common Pitfalls to Avoid
- Do not over-immobilize: Excessive immobilization leads to stiffness, which can be very difficult to treat after fracture healing and may require multiple therapy visits or additional surgical intervention 5
- Be aware that immobilization-related adverse events occur in approximately 14.7% of cases, including skin irritation and muscle atrophy 1
- Ensure patients understand the importance of moving uninvolved fingers regularly through complete range of motion 5
Special Considerations
For tuft fractures specifically, the surrounding soft tissue injury often requires more attention than the fracture itself 3. Address nail bed injuries, subungual hematomas, and open wounds appropriately, as these are common associated injuries in crush mechanisms.