Management of Non-Displaced Intra-Articular Fracture of the Distal Phalanx (D1)
For a non-displaced intra-articular fracture of the distal phalanx, treat conservatively with protective splinting for 3-4 weeks while initiating immediate active finger motion exercises to prevent stiffness. 1
Initial Treatment Approach
- Immobilize the affected digit with a protective splint (such as a stack splint or aluminum foam splint) for 3-4 weeks to allow fracture healing while protecting the joint surface 1
- Non-displaced intra-articular fractures of the distal phalanx rarely require surgical intervention, as the fracture fragments remain aligned and the joint surface is congruent 1
- The key distinction here is "non-displaced" - if there is any displacement >3mm or joint incongruity, surgical management becomes necessary 2, 3
Immediate Rehabilitation Protocol
- Begin active finger motion exercises of the proximal and middle phalanx joints immediately following diagnosis to prevent stiffness, which is the most functionally disabling complication 2, 4
- Finger motion in adjacent joints does not adversely affect adequately stabilized fractures 2, 4
- The DIP joint itself should remain protected in the splint during the initial healing phase
Follow-Up and Monitoring
- Obtain radiographic follow-up at approximately 3 weeks to confirm maintenance of alignment and adequate healing 2, 4
- Repeat imaging at the time of immobilization removal (typically 3-4 weeks) to ensure union before full mobilization 2, 4
- Monitor for any signs of displacement during the healing period, as this would necessitate surgical intervention 5
Red Flags Requiring Surgical Intervention
- Any displacement >3mm or loss of joint congruity mandates consideration of open reduction and internal fixation with K-wires or miniscrews 3, 5
- Intra-articular fractures involving >33% of the articular surface with displacement require surgical fixation to restore joint congruity and prevent post-traumatic arthritis 5
- Persistent pain or instability after conservative treatment may indicate symptomatic non-union requiring surgical fixation 6
Adjunctive Treatments
- Ice application provides benefit in the first 3-5 days post-injury for pain control 4
- Low-intensity ultrasound may improve pain and radiographic union in the short term, though long-term benefits are unproven 4
Common Pitfalls to Avoid
- Do not assume all distal phalanx fractures can be treated with simple buddy taping - intra-articular fractures require specific immobilization to protect the joint surface 1
- Failing to obtain adequate radiographs (including lateral views) may miss displacement or joint incongruity that requires surgical management 7
- Neglecting early finger motion exercises in adjacent joints leads to unnecessary stiffness and prolonged recovery 2, 4
- Immobilizing for longer than 4 weeks without clinical indication increases risk of joint stiffness without improving fracture outcomes 1