Initial Treatment for Distal Volar Finger Injury
For distal volar finger injuries, initiate immediate conservative management with wound debridement, application of artificial dermis with semi-occlusive dressings, and rigid splint immobilization for 3-6 weeks, while instituting early active motion exercises of uninvolved joints to prevent the most functionally disabling complication of finger stiffness. 1, 2, 3
Immediate Assessment and Imaging
- Obtain radiographs with at least 3 views to evaluate fracture pattern, degree of displacement, articular involvement, and associated soft tissue injuries 1
- Assess specifically for fragment displacement >3mm, involvement of more than one-third of the articular surface, palmar displacement of the distal phalanx, or interfragmentary gap >3mm, as these indicate need for surgical intervention 1
Initial Wound Management
- Perform wound debridement followed by application of artificial dermis (such as Pelnac®) and semi-occlusive dressing (such as IV3000®) for volar pulp tissue defects, which achieves excellent functional and aesthetic outcomes with minimal complications (3.22%) and mean treatment duration of 45 days 3
- For superficial wounds without significant tissue loss, allow granulation and spontaneous contraction 4
- In children, even amputations may heal by secondary intention with the fingertip sutured back as a biologic dressing, emphasizing preservation of digital length 4
- Direct closure may be used only for amputations of 2-3mm 4
Immobilization Protocol
- Apply rigid splint immobilization for 3-6 weeks for minimally displaced comminuted fractures 1
- For volar plate injuries, use dorsal protective splint for 2 weeks before starting active range of motion exercises 2
Critical Early Motion Strategy
- Institute active finger motion exercises immediately following diagnosis for all uninvolved joints, as finger motion does not adversely affect adequately stabilized fractures but failure to encourage early mobilization leads to severe, functionally disabling stiffness requiring multiple therapy visits or surgical intervention 1, 2, 5
- Patients presenting within 3 weeks of injury have significantly better outcomes, and delayed presentation worsens prognosis regardless of treatment method 2
- Instruct patients to move fingers regularly through complete range of motion to minimize stiffness complications 1
Surgical Indications
Surgery is indicated when:
- Fracture fragment displacement >3mm 1
- Articular surface involvement >one-third 1
- Palmar displacement of distal phalanx 1
- Interfragmentary gap >3mm 1
Follow-up Monitoring
- Obtain repeat radiographs at 10-14 days to ensure fracture position is maintained 5
- Monitor for proper fracture healing, restoration of finger function, development of stiffness, and persistent pain 1
- Unremitting pain during follow-up warrants immediate reevaluation for complications, malrotation, or loss of reduction 1, 5
Critical Pitfalls to Avoid
- The single most preventable complication is failure to encourage immediate active mobilization in stable injuries, which leads to severe stiffness that is entirely preventable with early motion 2
- Overlooking displacement or articular involvement leads to poor functional outcomes 1
- Delayed presentation beyond 3 weeks significantly worsens prognosis 2