What is the treatment for a non-displaced intraarticular proximal fracture?

Treatment of Non-Displaced Intraarticular Proximal Fracture

For non-displaced intraarticular proximal fractures, treat with removable splinting for 3-4 weeks combined with immediate active finger motion exercises, with mandatory surgical fixation if displacement exceeds 3mm, dorsal tilt exceeds 10 degrees, or any loss of joint congruity develops. 1, 2

Initial Treatment Approach

Removable splinting is the treatment of choice for truly non-displaced intraarticular fractures at proximal locations (metacarpal base, phalangeal base). 1, 3, 2

Immobilization Protocol

• Apply removable splint for 3-4 weeks duration 1, 2
• Begin active finger motion exercises immediately after diagnosis to prevent joint stiffness, which represents the most functionally disabling complication 1, 2
• Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 3

Special Consideration for Hip Fractures

If this question refers to proximal femoral (hip) fractures specifically, the management differs substantially:

• All undisplaced intracapsular hip fractures should undergo internal fixation with multiple screws or sliding hip screw, as conservative treatment carries a 30-50% risk of subsequent displacement 4
• Conservative treatment of hip fractures is associated with increased morbidity, mortality, and reduced chance of returning home 4

Critical Thresholds Requiring Surgical Intervention

Surgical fixation becomes mandatory if any of the following develop: 1, 3, 2

• Displacement >3mm 1, 3, 2
• Dorsal tilt >10 degrees 1, 3, 2
• Any loss of joint congruity on radiographs 1
• Intra-articular step-off of any significance 1

These thresholds exist because inadequate reduction leads to pain, functional disability, and early post-traumatic osteoarthritic changes. 1

Mandatory Follow-Up Protocol

Radiographic Surveillance

• Obtain radiographs at 3 weeks post-injury to detect delayed displacement that would require surgical conversion 1, 2
• Repeat imaging at time of immobilization removal (3-4 weeks) to confirm adequate healing 1, 3, 2
• Do not skip the 3-week follow-up, as delayed displacement requiring surgery can be missed 1

Expected Complication Rate

• Immobilization-related complications occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 1, 3, 2

Critical Pitfalls to Avoid

Do not rely on closed reduction and casting for displaced fractures, as this approach fails to maintain reduction in proximal fractures. 1

Do not underestimate the degree of displacement on initial radiographs—even seemingly minor intra-articular step-offs lead to post-traumatic arthritis. 1

Avoid prolonged immobilization beyond 4 weeks, as this causes joint stiffness that becomes the most disabling long-term complication. 1, 2

Never treat truly displaced fractures conservatively—for hip fractures specifically, conservative management of displaced intracapsular fractures leads to avascular necrosis of the femoral head, resulting in painful hip with limited function. 4

Rationale for Conservative Management

Conservative management with removable splinting for truly minimally displaced fractures avoids surgical risks while allowing early motion to prevent stiffness. 1 This approach balances the need for fracture stability with the critical importance of maintaining joint mobility and function, which directly impacts quality of life outcomes.