Treatment of Distal Phalanx Tuft Fractures
Distal phalanx tuft fractures should be treated conservatively with protective splinting for 3-4 weeks, as these crushing injuries rarely require specific fracture treatment and heal reliably with soft tissue management alone. 1
Initial Management
Conservative treatment is the standard approach for tuft fractures because:
- These fractures result from crushing mechanisms and the primary concern is soft tissue injury rather than bony alignment 1
- The fracture itself rarely needs specific treatment beyond protection 1
- Surgical intervention is reserved only for rare cases of nonunion, which is extremely uncommon 2, 3
Immobilization Protocol
Splint the affected digit for 3-4 weeks to allow healing:
- Use a protective splint that immobilizes the distal phalanx 1
- The splint protects the soft tissue envelope while the fracture heals 1
- Initiate active motion exercises of adjacent uninjured fingers immediately to prevent stiffness, as finger motion does not adversely affect adequately stabilized fractures 4
Follow-up Monitoring
Obtain radiographic follow-up at approximately 3 weeks to confirm adequate healing 4, 5
- Clinical assessment should focus on soft tissue healing (nail bed integrity, skin coverage) rather than radiographic union 1
- Monitor for complications including skin irritation or stiffness, which occur in approximately 14.7% of immobilization cases 4
Surgical Indications (Rare)
Surgery is almost never indicated for tuft fractures, but consider operative management only if:
- Symptomatic nonunion develops after conservative treatment (extremely rare) 2, 3
- Treatment would involve open reduction with Kirschner wire fixation and possible bone grafting 2, 3
Key Clinical Pitfall
Do not confuse tuft fractures with articular fractures of the distal phalanx, which have different treatment algorithms: