What type of splint is recommended for a fracture at the base of the left 2nd distal phalanx, similar to a finger gutter splint?

Splinting for Distal Phalanx Base Fracture

For a fracture at the base of the left 2nd distal phalanx, use a simple dorsal or volar splint that immobilizes only the distal interphalangeal (DIP) joint in slight flexion (15-30 degrees) for 4-6 weeks, NOT a finger gutter splint. 1

Why Not a Gutter Splint?

A gutter splint is designed to immobilize multiple adjacent fingers together and is typically used for metacarpal or proximal phalanx fractures requiring buddy taping support. For isolated distal phalanx fractures, this provides unnecessary immobilization of uninvolved joints and increases the risk of stiffness. 1

Appropriate Splinting Approach

For Uncomplicated Distal Phalanx Base Fractures:

• Splint only the DIP joint using a dorsal or volar finger splint that leaves the proximal interphalangeal (PIP) joint free to move 1, 2
• Position the DIP joint in slight flexion (15-30 degrees) to optimize healing and prevent extensor lag 1
• Duration of immobilization should be 4-6 weeks for uncomplicated fractures 1

Critical Distinction - Assess for Surgical Indications First:

• If there is displacement >3mm or articular step-off, surgical intervention is indicated rather than splinting alone 3
• If the fracture involves more than one-third of the articular surface, surgical fixation is required 3
• Joint instability or incongruity requires surgical management 3

Essential Concurrent Management

Immediate Active Motion Protocol:

• Begin active finger motion exercises immediately for all non-immobilized joints (PIP and MCP joints of the affected finger, plus all joints of adjacent fingers) 4, 5
• This is critical because finger stiffness is one of the most functionally disabling complications and can be very difficult to treat after fracture healing 4, 3
• Finger motion does not adversely affect adequately stabilized distal phalanx fractures 5

Follow-Up Protocol:

• Obtain radiographic follow-up at approximately 3 weeks to confirm maintained alignment 6, 5
• Repeat imaging at the time of splint removal to confirm adequate healing 6, 5

Common Pitfalls to Avoid

• Avoid over-immobilization by using a gutter splint or casting that restricts the PIP joint unnecessarily - this dramatically increases stiffness risk 3, 1
• Do not neglect active motion exercises of non-immobilized joints from day one - patients often avoid moving adjacent joints due to pain or apprehension 4
• Watch for open fracture components - distal phalanx base fractures can be associated with nail bed injuries that require separate management 7
• Recognize Seymour fractures (physeal injuries in children with nail bed involvement) which often require surgical debridement and fixation rather than simple splinting 7