Management of Distal Phalanx Base Fracture
For a horizontal lucency at the base of the left 2nd distal phalanx, apply a removable splint for 3-4 weeks with orthopedic follow-up at 3 weeks to confirm healing. 1
Immediate Immobilization in Urgent Care
Apply a removable splint to the affected finger, which is the appropriate treatment for minimally displaced distal phalanx fractures 1. The splint should:
- Immobilize the distal interphalangeal (DIP) joint while allowing proximal interphalangeal (PIP) joint motion
- Be maintained for 3-4 weeks duration 1
- Allow for swelling accommodation in the first 48-72 hours
Buddy taping to the adjacent finger (3rd digit) can be used as an adjunct to provide additional stability while permitting early mobilization 2.
Critical Early Management Points
Initiate active finger motion exercises immediately for the uninvolved joints (PIP and metacarpophalangeal joints) to prevent stiffness, which is the most functionally disabling complication 1. The American Academy of Orthopaedic Surgeons emphasizes that:
- Finger motion exercises do not adversely affect adequately stabilized fractures 1
- Over-immobilization leads to stiffness that is difficult to treat after fracture healing and may require multiple therapy visits or additional surgical intervention 1
- Patients must move uninvolved fingers regularly through complete range of motion 1
Orthopedic Follow-Up Protocol
Schedule orthopedic follow-up at 3 weeks with repeat radiographs to assess healing 1. The follow-up protocol should include:
- Initial radiographs (already obtained in UC) to confirm diagnosis and fracture pattern 1
- 3-week radiographic evaluation to assess healing progress 1
- Final radiographs at immobilization removal (typically 3-4 weeks) to confirm adequate healing 1
Red Flags Requiring Immediate Orthopedic Referral
Assess for features indicating need for surgical fixation rather than conservative management:
- Displacement >3mm 1
- Dorsal tilt >10° 1
- Intra-articular displacement 1
- Open fracture with skin disruption 3
- Vascular compromise (blue, purple, or pale digit) requiring emergency activation 3
Common Pitfalls to Avoid
Do not over-immobilize the entire finger or hand, as this leads to preventable stiffness 1. Specifically:
- Avoid rigid casting for minimally displaced fractures 1
- Do not immobilize joints proximal to the injury unnecessarily 1
- Monitor for immobilization-related complications (skin irritation, muscle atrophy) which occur in approximately 14.7% of cases 1
Ensure patient understands the importance of active motion exercises for uninvolved joints starting immediately, as patient compliance with this instruction significantly impacts functional outcomes 1.