Splinting Duration for Non-Displaced Finger Fractures
For non-displaced finger fractures, splint for 3-4 weeks with radiographic follow-up to assess healing, then transition to active motion exercises. 1
Splinting Protocol by Fracture Location
Distal Phalanx (Fingertip) Fractures
- Immobilize the distal interphalangeal (DIP) joint for 4-6 weeks using a rigid splint that protects the fracture site while allowing motion of unaffected joints 2
- The splint should be padded and comfortably tight but not constrictive 1, 3
- Begin active motion exercises immediately for unaffected joints to prevent stiffness 1, 3
Middle and Proximal Phalanx Fractures
- Use buddy taping for 3-4 weeks if the fracture has minimal angulation (less than 10 degrees) 2
- Rigid splinting should not exceed 3-4 weeks to avoid unnecessary stiffness 1
- Obtain radiographic follow-up at approximately 3 weeks to confirm adequate healing before discontinuing immobilization 1
Mallet Finger (Dorsal Avulsion Fractures)
- Strict splint immobilization for 8 weeks total is required for these DIP joint injuries 2
- Initial continuous splinting for 4-6 weeks, followed by night splinting to complete 8 weeks 4
- This extended duration is necessary despite being a distal phalanx injury due to the tendon involvement 2, 4
Active Motion Protocol
Begin active finger motion exercises immediately for all unaffected joints to prevent the most functionally disabling complication: finger stiffness 5, 1, 3
- Instruct patients at the first encounter to move unaffected fingers regularly through complete range of motion 5
- Finger motion does not adversely affect adequately stabilized fractures and provides significant impact on patient outcome 5, 1
- This intervention is extremely cost-effective, requiring no pharmaceutical intervention or additional visits 5, 1
Critical Time Limits
A broken finger should not be immobilized for more than one month except in specific cases like mallet finger 6
- Over-immobilization leads to unnecessary stiffness and poor functional outcomes 1
- Hand stiffness can be very difficult to treat after fracture healing, requiring multiple therapy visits and possibly surgical intervention 5
Common Pitfalls to Avoid
- Over-immobilization: Using rigid splinting when buddy taping would suffice leads to preventable stiffness 1
- Inadequate radiographic assessment: Obtain three views (PA, lateral, and oblique) initially, not just two views 1
- Delayed motion of unaffected joints: Failure to instruct patients about immediate active motion exercises for unaffected fingers increases risk of hand stiffness 5
- Extending immobilization beyond 4 weeks: Unless treating mallet finger, prolonged immobilization beyond one month causes more harm than benefit 6
Follow-Up Strategy
- Schedule radiographic follow-up at 3 weeks to assess healing progress 1
- Discontinue rigid immobilization once radiographic healing is evident, typically at 3-4 weeks for most non-displaced fractures 1, 2
- Transition to aggressive finger and hand motion exercises when immobilization is discontinued to facilitate optimal outcomes 5