Follow-Up Timing for Middle Phalanx Chip Fracture
Schedule the patient for orthopedic follow-up within 1-2 weeks of initial presentation, with repeat radiographs at 10-14 days if initial imaging was equivocal or to confirm fracture alignment. 1
Initial Management and Immobilization
- Immobilize the affected finger immediately using buddy taping or a splint to prevent displacement and allow early healing 1
- Provide appropriate pain management with acetaminophen as first-line, adding NSAIDs or opioids for severe pain as needed 2
- Most phalangeal fractures, including chip fractures, can be treated successfully with nonoperative means if the fracture is stable and has acceptable alignment 3
Follow-Up Schedule
First follow-up at 10-14 days:
- This timing allows for repeat radiographs to confirm fracture stability and detect any displacement that may have occurred during the initial healing phase 1
- If initial radiographs were equivocal, this follow-up is essential to exclude occult fractures that may become visible on delayed imaging 1
Orthopedic consultation within 1-2 weeks:
- Arrange definitive orthopedic evaluation for treatment planning, even for conservatively managed fractures 2
- This ensures appropriate assessment of fracture stability and determination of whether continued immobilization or early mobilization is appropriate 3
Early Mobilization Strategy
- Begin gentle range-of-motion exercises within the first few days once pain is controlled, as early mobilization is essential to prevent oedema and stiffness 1, 2
- When immobilization is discontinued (typically 2-4 weeks for stable chip fractures), aggressive finger and hand motion exercises are necessary to facilitate optimal outcomes 1
- Avoid overly aggressive physical therapy in the early postoperative or post-injury period, as this may increase risk of complications 1, 2
Red Flags Requiring Urgent Reassessment
Monitor the patient for the following complications that would necessitate earlier follow-up:
- Increasing pain, swelling, or loss of function suggesting fracture displacement 2
- Development of neurovascular compromise including numbness, tingling, or color changes 2
- Severe uncontrolled pain despite appropriate analgesia 2
- Inability to participate in basic activities of daily living due to mechanical block 2
Common Pitfalls to Avoid
- Do not delay follow-up beyond 2 weeks for initial reassessment, as this may lead to functional impairment if displacement occurs 1
- Avoid prolonged immobilization beyond what is necessary for fracture stability, as stiffness is the most common complication of phalangeal fractures, occurring in up to 52% of cases even with modern fixation techniques 4
- Recognize that soft-tissue crush injury (severe swelling or superficial skin injury) significantly worsens outcomes and may require closer monitoring 5
Documentation and Patient Education
- Document pain scores at rest and with movement before and after analgesia administration 6
- Educate the patient about the importance of early mobilization once cleared, signs of complications requiring urgent reassessment, and expected timeline for return to normal activities 1, 7
- Most patients with stable chip fractures can expect fracture union within 4-6 weeks with appropriate management 8