Management of Distal Phalanx Tuft Fracture of the Thumb
A stack splint is NOT appropriate for distal phalanx tuft fractures of the thumb; these fractures require rigid immobilization with a thumb spica cast or splint for 3-6 weeks. Stack splints are designed for mallet finger injuries at the distal interphalangeal joint of the fingers, not for thumb tuft fractures.
Appropriate Immobilization for Thumb Tuft Fractures
Rigid immobilization with a thumb spica cast or splint is the standard treatment for minimally displaced tuft fractures of the thumb 1. This approach differs fundamentally from stack splinting, which would provide inadequate stabilization for the thumb's unique biomechanics and injury pattern.
Key Treatment Principles
- Most tuft fractures are sustained in crushing injuries and require care for surrounding soft tissues rather than specific fracture treatment 2
- The fracture itself rarely needs surgical intervention unless specific criteria are met 2
- Rigid immobilization should be maintained for 3-6 weeks 1
When Conservative Management is Appropriate
- Fracture displacement <2-3mm 1
- No significant articular involvement
- Adequate soft tissue coverage without open fracture concerns
Follow-up Protocol
- Obtain follow-up radiographs at 10-14 days to ensure fracture position is maintained 1
- Monitor for pain relief and restoration of function throughout the healing period 1
Indications for Surgical Intervention
Surgery should be considered when:
- Fracture fragment displacement >3mm 1
- Involvement of more than one-third of the articular surface 1
- Conservative treatment fails to provide pain relief or restore function 1
- Symptomatic nonunion develops (rare but possible) 3, 4
Surgical Options
- Variable pitch headless compression screws can be used percutaneously for shaft fractures or nonunions 4
- Open reduction with Kirschner wire fixation for displaced articular fractures 5
Critical Pitfalls to Avoid
- Do not use stack splints for thumb injuries—they are biomechanically inappropriate and will not provide adequate immobilization
- Initial radiographs must include at least 2 views (PA and lateral), though adding an oblique view increases diagnostic yield 6, 1
- Be vigilant for open fractures with nailbed injuries, which require different management 7
- Nonunions of the shaft (as opposed to the tuft) are usually symptomatic enough to warrant treatment if they occur 4