What is the recommended management for a Salter-Harris type II fracture of the proximal phalanx of the little finger with mild angulation?

From the Guidelines

For a Salter-Harris type II fracture of the proximal phalanx of the little finger with mild angularity, I recommend closed reduction followed by immobilization with buddy taping to the adjacent ring finger for 3-4 weeks. The reduction should be performed using gentle longitudinal traction and correcting the angulation. After reduction, apply a custom-made aluminum foam splint or a prefabricated ulnar gutter splint maintaining the finger in a functional position (slight flexion at the MCP and PIP joints). The splint should be worn for the first 2 weeks, followed by buddy taping for an additional 1-2 weeks. During this period, early protected range of motion exercises should be initiated to prevent stiffness. Acetaminophen or ibuprofen can be used for pain management as needed. Follow-up radiographs should be obtained at 1 week and 3 weeks post-reduction to ensure proper alignment and healing. This approach is recommended because Salter-Harris type II fractures in children have excellent healing potential due to the thick periosteum and active growth plates. The mild angulation can typically be corrected with closed reduction, and children can remodel small residual deformities. Immobilization should not be prolonged to avoid joint stiffness, which is why early protected motion is important after the initial healing phase, as supported by the principles outlined in 1.

Some key points to consider in the management of this condition include:

• The importance of gentle reduction to avoid further injury
• The use of immobilization to promote healing and reduce pain
• The need for early protected range of motion exercises to prevent stiffness
• The role of pain management with acetaminophen or ibuprofen as needed
• The importance of follow-up radiographs to ensure proper alignment and healing, as implied by the general principles of fracture management in 1 and 1.

It is essential to prioritize the patient's morbidity, mortality, and quality of life when making management decisions, and to base these decisions on the most recent and highest-quality evidence available, which in this case supports a conservative approach with closed reduction and immobilization.

From the Research

Management of Salter Harris Type II Fracture

• The management of Salter-Harris type II fractures of the proximal phalanx is based on the initial severity of the injury and depends on the success of closed reduction techniques 2, 3.
• Nondisplaced phalanx fractures are managed with splint immobilization, while stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction 2, 3.
• Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning 2, 3.
• For fractures with mild angularity, nonsurgical management may be appropriate, with studies showing good long-term outcomes for children with up to 26° of initial coronal plane angulation 4.
• It is essential to assess the digital cascade for signs of rotational deformity and/or coronal malalignment, as rotational deformities can occur even with minimal angulation 5.

Considerations for Nonsurgical Management

• Nonsurgical management of Salter-Harris type II fractures of the proximal phalanx can be effective, with high patient-reported outcomes regarding function, appearance, and pain 4.
• Children with mild angularity and no rotational deformity may be candidates for nonsurgical management, with close monitoring to ensure maintenance of fracture reduction 2, 3.
• The degree of acceptable angulation for nonsurgical management is still unclear, but studies suggest that up to 26° of initial coronal plane angulation may be acceptable 4.