From the Guidelines
Treatment for a 5th toe proximal phalanx fracture typically involves simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as noted in a study published in the American Family Physician in 2002 1. The diagnosis of a 5th toe proximal phalanx fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.
Key Considerations
- Immobilization is appropriate for small, nonarticular, or minimally displaced fractures
- Surgery is usually reserved for more complex cases, such as severely displaced, rotated, or open fractures
- Conservative management is often sufficient due to the minimal weight-bearing role of the 5th toe and its surrounding soft tissue support
Management Approach
- Protected weight-bearing and immobilization can be achieved through the use of a post-operative or hard-soled shoe for 3-4 weeks
- Pain management may include acetaminophen or NSAIDs for a short period, typically 5-7 days
- Follow-up is recommended in 1-2 weeks to ensure proper healing, with gradual return to normal activities as pain subsides, usually after 4-6 weeks.
From the Research
Treatment Options for 5th Toe Proximal Phalanx Fracture
- Non-surgical management with immediate mobilization can be used for isolated stable or initially unstable proximal phalangeal fractures without uncorrectable toe rotation or fracture angulation exceeding 25° in the sagittal plane or 10° in the coronal plane following closed reduction 2
- Surgical intervention may be required for unstable fracture patterns and those involving the articular surface, with options including percutaneous pinning, open reduction and internal fixation, and lag screws 3, 4
- The goal of proximal phalangeal fracture management is to allow for fracture healing to occur in acceptable alignment while maintaining gliding motion of the extensor and flexor tendons 5
Surgical Techniques
- Closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws) are two surgical techniques used to treat long oblique extra-articular proximal phalanx fractures, with similar functional outcomes and complication rates 4
- Open reduction and internal fixation can be used to treat proximal phalangeal fractures, with most recovery in range of motion, pain, strength, and hand use occurring by 6 weeks after operation 6