Recommended Splint for Non-Displaced Oblique Fracture of Distal First Phalanx Base
A removable splint is the appropriate treatment for this non-displaced phalangeal fracture, as it provides adequate immobilization while allowing for early finger motion to prevent stiffness. 1, 2
Rationale for Removable Splinting
Non-displaced fractures of the phalanx can be safely managed with removable splints rather than rigid casting, as demonstrated in pediatric phalangeal neck fractures where splinting showed equivalent radiologic and clinical outcomes to casting 2
The splint should immobilize the fracture site while allowing motion of adjacent joints (the proximal interphalangeal and distal interphalangeal joints) to prevent stiffness, which is one of the most functionally disabling complications of finger fractures 1, 3
Finger motion does not adversely affect adequately stabilized phalangeal fractures in terms of reduction or healing 1
Splint Application Technique
Use a custom-molded thermoplastic splint that can be fashioned to protect the fracture site while permitting controlled motion 4
Obtain standard 3-view radiographs before and after splint application to confirm proper alignment 1
The splint design should allow for removal to change dressings and perform radiographic evaluations 4
Duration and Follow-Up
Maintain immobilization for approximately 3 weeks with radiographic follow-up at that time to confirm adequate healing 1, 3
Initiate active finger motion exercises immediately following diagnosis to prevent joint stiffness 1, 3
Monitor for immobilization-related complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of cases 3
Important Caveats
If displacement exceeds 3mm, dorsal tilt exceeds 10°, or there is significant intra-articular involvement, surgical management should be considered instead 1, 3
For truly intra-articular fractures with displacement, conservative management with splinting alone is not typically recommended due to risk of joint incongruity and subsequent arthritis 3
Since this is a non-displaced oblique fracture at the base of the first phalanx, verify there is no rotational malalignment clinically before proceeding with splinting 1