What type of splint is recommended for a middle phalanx fracture of the ring and middle fingers?

Splinting for Middle Phalanx Fractures of the Ring and Middle Fingers

For uncomplicated middle phalanx fractures with minimal angulation (<10 degrees), use buddy taping to an adjacent uninjured finger, which allows early mobilization while providing adequate stability. 1

Initial Assessment and Imaging

Before selecting a splint, obtain proper radiographic evaluation:

• Three-view radiographs (PA, lateral, and oblique) are essential for middle phalanx fractures to detect displacement, angulation, and articular involvement 2
• An internally rotated oblique projection in addition to standard views increases diagnostic yield for phalangeal fractures 2
• Assess the digital cascade clinically for rotational deformity or coronal malalignment, which would change management 3

Splinting Algorithm Based on Fracture Pattern

Uncomplicated Fractures (Non-displaced or Minimal Angulation <10°)

• Buddy splinting is the treatment of choice for stable middle phalanx fractures with minimal angulation 1
• Tape the injured finger to an adjacent uninjured finger, which provides dynamic support while allowing early active motion 1
• This approach prevents the stiffness that commonly occurs with rigid immobilization 4

Fractures Requiring Rigid Immobilization

For fractures with moderate displacement or after successful closed reduction:

• Use a rigid finger splint that immobilizes the proximal interphalangeal (PIP) joint while allowing metacarpophalangeal (MCP) joint motion 5
• The splint should be padded and comfortably tight but not constrictive 5
• Position the finger in the "safe position" with slight flexion at the PIP joint to prevent joint contracture 1

Fractures Requiring Referral

Refer immediately to orthopedic surgery for:

• Angulation >10 degrees 1
• Displacement or malrotation 1
• Unstable fractures that cannot maintain reduction 3
• Intra-articular fractures with articular surface displacement 6
• Type 1 palmar avulsion fractures (unstable) or type 2 dorsal avulsion fractures (risk of boutonniere deformity) 6

Active Motion Protocol

Critical pitfall to avoid: Prolonged rigid immobilization leads to debilitating stiffness, which is the most functionally disabling complication of hand fractures.

• Begin active finger motion exercises immediately for buddy-taped fractures 5
• Active motion does not adversely affect adequately stabilized fractures and is extremely cost-effective 7, 5
• For fractures requiring rigid splinting, begin motion exercises as soon as stability allows, typically within 2-3 weeks 4

Duration of Immobilization

• Buddy taping: Continue for 3-4 weeks with progressive return to activity 1
• Rigid splinting (if required): 3-4 weeks with radiographic follow-up 8
• Obtain radiographic follow-up at approximately 3 weeks to assess healing 8, 5

Common Pitfalls

• Over-immobilization: Rigid splinting when buddy taping would suffice leads to unnecessary stiffness 7
• Missing rotational deformity: Always assess the digital cascade clinically, as even small rotational malalignment causes significant functional impairment 3
• Inadequate initial radiographs: Two views are insufficient; obtain three views including oblique projections 2
• Delayed mobilization: Waiting too long to start active motion exercises results in prolonged rehabilitation 4