What is the treatment for a phalanx fracture?

Treatment of Phalanx Fractures

Most phalangeal fractures can be successfully treated nonoperatively with immobilization, while unstable fractures, articular incongruity, or significant soft tissue damage require surgical intervention. 1

Initial Assessment and Stabilization

Emergency Management

• Immediately activate emergency services if the fractured finger appears blue, purple, or pale, as this indicates compromised perfusion and represents a limb-threatening injury 2
• Control any severe bleeding before addressing the fracture itself 2
• Splint the injured finger in the position found to reduce pain, prevent further injury, and facilitate transport, unless straightening is necessary for safe transport 2
• Cover any open wounds with a clean dressing to reduce contamination and infection risk 2

Diagnostic Imaging

• Obtain standard radiographs in all cases to confirm the fracture pattern, assess stability, and rule out other bony abnormalities 3
• Advanced imaging (MRI or CT) is not routinely necessary for straightforward phalangeal fractures 4

Treatment Algorithm

Nonoperative Management (Most Fractures)

Indications: Nondisplaced fractures, stable fractures after successful closed reduction 1, 5

• Use rigid immobilization rather than removable splints for displaced fractures requiring nonsurgical treatment 2
• Position the hand with the wrist dorsiflexed 30° and metacarpophalangeal joints flexed 70-90° (intrinsic plus position) to maintain fracture stability 6
• Begin early finger motion exercises immediately to prevent edema and stiffness 2
• Active exercises in the interphalangeal joints should start early to prevent mobility limitations and rotational deformities 6
• Monitor closely to ensure maintenance of fracture reduction, as unstable fractures may require conversion to surgical management 5

Surgical Management

Indications: 1, 7

• Unstable fractures that cannot maintain reduction
• Articular incongruity or displacement
• Concomitant soft tissue damage requiring operative intervention
• Open fractures
• Situations where anatomy restoration and function preservation require operative stabilization

Surgical principles: 1, 7

• Achieve anatomic reduction with stable fixation
• Use meticulous surgical technique with careful soft tissue handling
• Initiate early postoperative mobilization where indicated
• Multiple fixation options available (K-wires, plates, screws, external fixation) based on fracture pattern and surgeon experience

Rehabilitation

Early Phase

• For both operative and nonoperative treatment, early mobilization is critical 2
• When immobilization is discontinued, aggressive finger and hand motion exercises are necessary for optimal outcomes 2
• The goal is to achieve bony healing and free mobility simultaneously, not sequentially 6

Long-term Recovery

• Most patients (86%) achieve full range of motion with appropriate functional treatment 6
• Continue balance training and fall prevention programs for elderly patients to prevent subsequent fractures 2

Common Pitfalls

• Avoid removable splints for displaced fractures requiring nonsurgical treatment, as rigid immobilization provides superior outcomes 2
• Do not delay surgical referral for unstable fractures, as early intervention optimizes functional outcomes 1, 5
• Never neglect early mobilization exercises, as delayed rehabilitation leads to stiffness and poor functional outcomes 2, 6
• Be vigilant for vascular compromise (color changes) requiring immediate intervention 2
• Ensure close follow-up for conservatively managed fractures to detect loss of reduction early 5