Treatment of Non-Displaced Proximal Metatarsal Fracture in a 3-Year-Old
For a 3-year-old with a non-displaced fracture of the proximal metaphysis of the great toe metatarsal, buddy taping to the second toe with a rigid-sole shoe is the appropriate treatment.
Splinting Approach
Primary Immobilization Method
- Buddy taping is the recommended splinting technique for stable, non-displaced toe fractures in children 1, 2.
- Place padding (gauze or cotton) between the great toe and second toe to prevent skin maceration 1.
- Secure the toes together with medical tape, changing the tape every few days or when it becomes loose 2.
Footwear Requirements
- A rigid-sole shoe (cast shoe or stiff-soled shoe) should be worn to limit joint movement and protect the fracture site 1, 2.
- The rigid sole prevents excessive flexion at the metatarsophalangeal joint, which is critical for healing 3.
- This combination allows protected weight-bearing while maintaining fracture stability 3.
Duration of Immobilization
- Maintain buddy taping and rigid-sole shoe for 3-6 weeks until clinical and radiographic evidence of healing 1, 3.
- Radiographic follow-up should occur at approximately 3 weeks to assess healing progress 1.
- Weight-bearing as tolerated is appropriate for stable, non-displaced fractures like this one 1.
Why This Approach is Optimal
Avoids Overtreatment
- Long-term immobilization including the ankle joint is unnecessary for non-displaced metatarsal fractures 4.
- Casting or more rigid splinting would restrict normal movement of unaffected joints, potentially causing stiffness 1.
- In young children, excessive immobilization can impair normal developmental activities.
Fracture Stability Considerations
- Non-displaced fractures of the metatarsals can be treated conservatively with excellent outcomes 3, 4.
- The proximal metaphysis has good blood supply, promoting reliable healing 5.
- Since the growth plate is not involved, there is no risk of physeal arrest requiring more aggressive management 2.
Critical Pitfalls to Avoid
- Do not overtighten the buddy tape, as this can compromise circulation to the toes 1.
- Monitor for signs of poor perfusion (blue, purple, or pale appearance of the toe), which would require immediate medical attention 1.
- Avoid attempting to manipulate or straighten the fracture since it is already non-displaced 6.
- Do not use a short-leg cast unless there are specific concerns about compliance or additional injuries, as this represents overtreatment for a stable fracture 3, 4.
When to Consider Referral
While not needed in this case, referral would be indicated for 2:
- Displaced fractures involving more than 25% of the joint surface
- Fracture-dislocations
- Open fractures or significant soft tissue injury
- Circulatory compromise
- Unstable fractures requiring reduction