Treatment for Tufted Fracture of Phalanx
Tufted fractures of the distal phalanx rarely require specific fracture treatment and should be managed primarily with wound care, pain control, and protective splinting for 2-3 weeks, as these injuries are sustained through crushing mechanisms that prioritize soft tissue management over fracture reduction. 1
Initial Management
Immediate Assessment:
- Check for vascular compromise (blue, purple, or pale appearance) which represents a limb-threatening emergency requiring immediate intervention 2
- Control any active bleeding before addressing the fracture 2
- Cover open wounds with clean dressing to minimize infection risk 2
- Obtain standard radiographs to confirm fracture pattern and rule out other injuries 2
Treatment Algorithm
Non-Displaced Tufted Fractures (Most Common)
Primary treatment focuses on soft tissue care rather than fracture-specific intervention 1:
- Protective splinting for comfort and wound protection (typically 2-3 weeks) 1
- Early mobilization should begin immediately to prevent edema and stiffness 2
- Pain management with appropriate analgesics 1
- Wound care for associated nail bed injuries or soft tissue damage 1
Displaced Articular Fractures (Rare Exception)
Surgical intervention is indicated only for 1:
- Palmar articular fractures with flexor digitorum profundus tendon avulsion requiring surgical reattachment 1
- Fracture displacement >3mm 2, 3
- Articular involvement >1/3 of joint surface 2, 3
Note: Dorsal articular fractures (mallet fractures) should be treated nonoperatively despite displacement 1
Rehabilitation Protocol
Early mobilization is critical for optimal outcomes 2:
- Begin finger motion exercises immediately when pain allows 2
- Discontinue immobilization at 2-3 weeks for most tufted fractures 1
- Initiate aggressive range-of-motion exercises once splinting is discontinued 2
Follow-Up
- Obtain repeat radiographs at 10-14 days to ensure maintained position if there was any initial displacement 3
- Monitor for pain relief and functional restoration 3
Critical Pitfalls to Avoid
- Do not over-treat: The fracture itself rarely needs specific intervention; crushing injuries require soft tissue management as the priority 1
- Avoid prolonged immobilization: Extended splinting beyond 3 weeks leads to stiffness and poor functional outcomes 2
- Do not miss vascular compromise: Color changes require immediate intervention 2
- Avoid removable splints for truly displaced fractures: If rigid immobilization is needed, use fixed splinting 2