From the Guidelines
The treatment for an avulsion of the anterior base of the middle phalanx of the 5th finger typically involves immobilization with a splint for 3-4 weeks, with early protected range of motion exercises starting after 1-2 weeks to prevent stiffness. This approach is based on the principles outlined in the management of acute hand and wrist trauma, where radiography is always indicated as the initial imaging for suspected acute hand and wrist trauma 1. For phalangeal injuries, such as the one described, a standard 3-view radiographic examination of the hand is usually sufficient to show most fractures and dislocations of the metacarpals and phalanges 1. In the case of an avulsion of the anterior base of the middle phalanx, the treatment plan should consider the size of the avulsed fragment and the degree of joint instability. Key considerations in the treatment plan include:
- Immobilization with a splint for 3-4 weeks to allow for healing of the avulsed fragment
- Early protected range of motion exercises starting after 1-2 weeks to prevent stiffness
- Pain management with acetaminophen or ibuprofen as needed
- Follow-up with a hand specialist at 1-2 weeks to assess healing and potentially adjust the treatment plan
- Return to full activities typically occurs at 6-8 weeks, with protective taping for sports recommended for an additional 2-4 weeks. It is also important to note that complete tears with large displaced fragments (>30% of the articular surface) or joint instability may require surgical fixation, as indicated by the involvement of more than one-third of the articular surface or palmar displacement of the distal phalanx or an interfragmentary gap of >3 mm 1.
From the Research
Treatment of Avulsion of Anterior Base of the Middle Phalanx 5th Finger
- The treatment of avulsion fractures of the base of the middle phalanx depends on the type and stability of the fracture 2.
- Surgery is recommended for unstable type-1 avulsion fractures, type-2 avulsions which may develop buttonhole deformities, and all fractures which displace articular cartilage surfaces 2.
- A volar A1 pulley approach can be used for fixation of avulsion fractures of the base of the proximal phalanx, allowing for anatomic restoration of the articular surface and collateral ligament stability 3.
- The decision for operative treatment is most strongly associated with the presence of an articular step or gap, likelihood of subluxation or dislocation, and unstable fractures 4.
- Open reduction and internal fixation can be used to treat large volar plate avulsion fractures at the base of the middle phalanx with significant displacement, allowing for anatomic alignment and stability of the fracture 5.
- A technique for the repair of chronic volar plate avulsion of the proximal interphalangeal joint involves freeing the volar plate from scar, creating a new connection to the middle phalanx, and loosely attaching the volar plate distally, resulting in improved range of motion and reduced pain 6.