What is the recommended treatment for an acute left fifth proximal phalanx fracture that is minimally displaced by 0.1 cm volarly?

Treatment for Acute Left Fifth Proximal Phalanx Fracture with Minimal Volar Displacement (0.1 cm)

This minimally displaced proximal phalanx fracture should be treated conservatively with buddy taping to the fourth digit and immediate mobilization, as the 0.1 cm displacement does not meet surgical thresholds and conservative management achieves excellent functional outcomes for fifth digit base fractures. 1

Treatment Algorithm

Conservative Management (Recommended)

Buddy taping with immediate mobilization is the treatment of choice for this fracture pattern based on the following criteria:

• Displacement is well below surgical threshold: The 0.1 cm (1 mm) volar displacement is far less than the >3 mm interfragmentary gap that would indicate surgical intervention 2
• No articular involvement requiring surgery: Surgical indications for proximal phalanx fractures include unicondylar fractures with >1/3 articular surface involvement or palmar displacement with >3 mm gap, neither of which applies here 2
• Fifth digit base fractures respond excellently to conservative care: A prospective study of 53 consecutive fifth digit proximal phalanx base fractures treated with buddy taping showed high satisfaction, full flexion in all but one patient, and no nonunion or delayed union 1

Specific Treatment Protocol

Initial management:

• Perform closed reduction if any displacement requires correction 1
• Apply buddy taping to the fourth (ring) finger 1
• Begin immediate mobilization—do not immobilize in a cast 1

Follow-up imaging:

• Repeat radiographs at 10-14 days to monitor for displacement 3
• Additional imaging at 4-6 weeks to confirm healing 4

Why Surgery is NOT Indicated

This fracture is inherently stable and does not require surgical stabilization 5:

• Stable fractures can be treated with splints or buddy taping 6
• Surgical fixation (Kirschner wires, plates, or screws) is reserved for unstable fractures, which typically involve significant displacement, rotation, or articular involvement 6, 5
• Internal fixation often leads to decreased finger mobility despite exact reduction 1

Expected Outcomes with Conservative Management

Functional outcomes are superior to anatomic perfection in fifth digit fractures 1:

• Full flexion recovery expected in >98% of cases 1
• Satisfactory extension with minimal extensor lag 1
• High patient satisfaction despite minor residual radiographic abnormalities 1
• Malrotation requiring corrective surgery is rare (occurred in 0/53 patients in one series) 1

Critical Pitfalls to Avoid

Do not over-treat with rigid immobilization or surgery:

• Prolonged immobilization leads to stiffness and poor functional outcomes 7, 1
• Surgical fixation for minimally displaced fractures increases complication risk without improving outcomes 1
• Focus treatment on function rather than perfect anatomic alignment for the fifth digit 1

Monitor for loss of reduction:

• The main risk with conservative management is subsequent displacement, though this is uncommon with proper buddy taping 1
• Early follow-up radiographs at 10-14 days are essential to catch any displacement before it becomes problematic 3