Buddy Strapping for Finger Injuries
Buddy strapping (buddy taping) is an effective and recommended first-line treatment for most finger sprains, hyperextension injuries, and stable extra-articular fractures, offering comparable outcomes to rigid splinting while providing superior patient comfort and earlier recovery. 1, 2
Indications for Buddy Strapping
Buddy strapping is most appropriate for:
- Proximal interphalangeal (PIP) joint hyperextension injuries and sprains without fracture 3, 1
- Stable, minimally displaced finger fractures (particularly extra-articular fractures in children) 2
- Volar plate disruptions (Eaton and Littler types I and II) 4
- Metacarpophalangeal (MCP) joint injuries 3
- Toe fractures and sprains 3
Proper Technique and Duration
Apply buddy strapping for approximately 1 week for soft tissue injuries, with the injured finger taped to an adjacent healthy finger 1, 4. For fractures in children, buddy taping can be continued for the full healing period (typically 3-4 weeks) 2.
Key technical points:
- Use appropriate tape that minimizes skin irritation - standard adhesive tape is commonly used 3
- Place padding or barrier material between fingers to prevent skin-to-skin maceration and friction injuries 3
- Avoid excessive tightness that could compromise circulation 3
- Combine with dorsal night splinting in 10° flexion for volar plate injuries 4
Early Active Motion Protocol
Immediately instruct patients to perform active finger range of motion exercises through complete flexion and extension, as finger motion does not adversely affect adequately stabilized fractures and prevents the most functionally disabling complication—finger stiffness 5, 6. This intervention is cost-effective and significantly impacts patient outcomes 5.
Contraindications and When to Consider Alternative Treatment
Do not use buddy strapping for:
- Displaced fractures with >3mm displacement or >1/3 articular surface involvement - these require surgical consideration 6
- Open fractures - require wound management first 5
- Fractures requiring reduction - particularly little finger fractures after reduction have higher secondary displacement rates and may benefit from splinting 2
Common Complications and Prevention
The most frequent complications include:
- Skin injuries at adhesive sites (observed by 45% of surgeons) 3
- Skin maceration between taped fingers (45% of cases) 3
- Low patient compliance (65% of surgeons report this issue) 3
- Loss of fixation if tape loosens 3
To minimize complications:
- Use padding between fingers 3
- Educate patients on proper tape maintenance and replacement 3
- Schedule early follow-up within 24 hours to assess technique and compliance 5
- Monitor for skin breakdown at each visit 3
Comparative Effectiveness
Buddy strapping demonstrates non-inferior outcomes compared to aluminum splints or rigid immobilization for appropriate injuries 1, 2. Specific advantages include:
- Earlier recovery of motion, edema resolution, and pain relief in patients who achieve full recovery 1
- Significantly higher patient comfort scores 2
- Lower treatment costs 2
- Similar or better range of motion outcomes (median 95° TAM vs 90° TAM with splinting) 4
- Comparable treatment duration and session requirements 4
Pediatric Considerations
Children demonstrate better outcomes than adults with PIP joint injuries 1. For pediatric extra-articular finger fractures, buddy taping is non-inferior to splinting for undisplaced fractures, though displaced little finger fractures after reduction warrant closer monitoring due to higher secondary displacement risk 2.