Treatment of Comminuted Distal Phalanx Tuft Fracture
Treat comminuted distal phalanx tuft fractures with removable splinting for 3-4 weeks combined with immediate active finger motion exercises of uninvolved joints. 1
Initial Management Approach
Conservative treatment is the standard of care for tuft fractures regardless of comminution. These crushing injuries require attention to soft tissue management rather than specific fracture fixation. 2 The fracture itself rarely needs surgical intervention because:
- Tuft fractures heal reliably with immobilization alone 2
- The comminution pattern does not affect treatment decisions for this fracture location 1
- Surgical fixation criteria (>3mm displacement, >10° dorsal tilt, intra-articular displacement) apply to articular fractures, not tuft fractures 1
Specific Treatment Protocol
Immobilization Strategy
- Apply a removable splint (not rigid casting) for 3-4 weeks 1
- This allows for soft tissue care while protecting the fracture 1
Critical Motion Protocol
Start active finger motion exercises immediately after diagnosis to prevent stiffness, which is the most functionally disabling complication. 1 Specifically:
- Move all uninvolved fingers through complete range of motion regularly 1
- Finger motion does not adversely affect adequately stabilized fractures 1
- Avoid over-immobilization, as excessive immobilization causes stiffness that may require multiple therapy visits or additional surgical intervention 1
Follow-Up Requirements
Obtain radiographs at:
- 3 weeks post-injury to assess healing progression 1, 3
- At time of immobilization removal to confirm adequate healing 1
Complications to Monitor
- Immobilization-related adverse events occur in approximately 14.7% of cases, including skin irritation and muscle atrophy 1
- Joint stiffness from inadequate motion exercises 1
When Surgery Is NOT Indicated
Unlike shaft or neck fractures of the distal phalanx, tuft fractures do not develop symptomatic nonunion requiring surgical intervention. 4, 5 The comminuted pattern in tuft fractures is managed conservatively because the fracture fragments are contained within the soft tissue envelope and heal through periosteal callus formation. 2