Finger Splint for Distal Phalanx Base Fracture
For a fracture at the base of the left 2nd distal phalanx, use a dorsal finger splint that immobilizes only the distal interphalangeal (DIP) joint while allowing full motion of the proximal interphalangeal (PIP) joint. 1
Splint Selection and Design
- Apply a modified dorsal finger splint that extends from the fingertip to just proximal to the PIP joint, maintaining the DIP in neutral to slight flexion (0-10 degrees) 1
- The dorsal design prevents complications like skin maceration and allows for better patient comfort during the 3-4 week healing period 1
- Ensure the splint immobilizes the fracture site while specifically allowing PIP joint motion to prevent stiffness 2, 3
Application Principles
- Obtain standard 3-view radiographs before splint application to confirm alignment and rule out significant displacement (>3mm) or intra-articular involvement 2
- The splint should be rigid rather than removable for displaced fractures to maintain reduction 4
- For minimally displaced fractures, a removable splint is acceptable 4
Duration and Follow-up
- Maintain splinting for approximately 3-4 weeks (average 24 days) 3
- Obtain radiographic follow-up at 3 weeks to confirm adequate healing 2, 3
- Repeat imaging at cessation of immobilization to ensure maintained alignment 4, 3
Critical Motion Protocol
- Begin active finger motion exercises immediately for the PIP and metacarpophalangeal (MCP) joints - this is essential to prevent stiffness, which is one of the most functionally disabling complications 4, 3
- Finger motion does not adversely affect adequately stabilized distal phalanx fractures 4, 2
- Keep the DIP joint immobilized but move all other finger joints through complete range of motion multiple times daily 4
Red Flags Requiring Surgical Referral
- Displacement >3mm 2
- Dorsal tilt >10° 2
- Significant intra-articular involvement 2
- Open fracture with skin disruption 4
- Blue, purple, or pale finger indicating compromised perfusion 4
Common Pitfalls to Avoid
- Do not immobilize the PIP joint - this leads to unnecessary stiffness and prolonged recovery 4, 3
- Monitor for immobilization-related complications including skin irritation and muscle atrophy, which occur in approximately 14.7% of cases 3, 5
- Avoid overtightening any compression wrap as this can compromise circulation 4
- Do not delay radiographic follow-up - loss of alignment can occur during the healing period 4