What is the treatment for a non-displaced oblique fracture through the radial margin of the distal first phalanx base?

Treatment of Non-Displaced Oblique Fracture Through Radial Margin of Distal First Phalanx Base

Apply a removable splint that immobilizes the distal interphalangeal (DIP) joint while allowing proximal interphalangeal (PIP) joint motion for 3-4 weeks. 1

Initial Assessment

• Obtain standard 3-view radiographs (anteroposterior, lateral, and oblique) to confirm the fracture is truly non-displaced and to document proper alignment before initiating treatment 1
• Confirm displacement is <3mm and angulation is <10° dorsal tilt, as these thresholds define non-displaced fractures that can be managed conservatively 1
• The presence of intra-articular extension at the base of the distal phalanx does not change conservative management when the fracture is non-displaced 1

Splinting Protocol

• Use a removable splint that specifically immobilizes only the DIP joint while permitting full PIP joint motion 1
• This approach differs from complete finger immobilization and prevents unnecessary stiffness in adjacent joints 1
• Duration of immobilization should be 3-4 weeks 1
• Uncomplicated distal phalanx fractures typically require splinting for four to six weeks, though non-displaced fractures at the base may heal adequately with the shorter 3-4 week timeframe 2

Rehabilitation During Treatment

• Begin active finger motion exercises immediately for all non-immobilized joints (PIP and metacarpophalangeal joints) to prevent stiffness 1
• Finger motion in non-immobilized joints does not adversely affect adequately stabilized fractures 3
• Joint stiffness is a common complication without proper early mobilization of adjacent joints 1

Follow-Up Schedule

• Perform radiographic follow-up at approximately 3 weeks post-immobilization to assess healing progress 1
• Obtain additional radiographs at the time of immobilization removal (3-4 weeks) to confirm adequate healing before discontinuing the splint 1

Potential Complications to Monitor

• Immobilization-related adverse events occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 1
• Intra-articular fractures carry risk of post-traumatic arthritis if alignment is lost during healing 1
• Monitor for any displacement on follow-up radiographs that would necessitate surgical intervention 1

When Surgical Referral Is Indicated

• If displacement exceeds 3mm, dorsal tilt exceeds 10°, or significant intra-articular displacement develops during treatment, surgical fixation becomes necessary 3, 4
• Any malrotation or loss of reduction on follow-up imaging warrants orthopedic consultation 2