Treatment of Distal Phalanx Tuft Fractures
Tuft fractures of the distal phalanx should be treated with splinting of the distal interphalangeal (DIP) joint for 4-6 weeks, combined with immediate active motion exercises of all uninvolved finger joints to prevent stiffness. 1, 2
Initial Management
- Apply a removable splint to immobilize only the DIP joint for minimally displaced tuft fractures 1
- Tuft fractures are typically caused by crush injuries and rarely require specific fracture treatment beyond soft tissue care 3
- The splint duration should be 4-6 weeks for uncomplicated tuft fractures 2
Critical Motion Protocol to Prevent Complications
- Immediately initiate active finger motion exercises for all uninvolved joints (proximal interphalangeal and metacarpophalangeal joints) at the first encounter 1
- Finger motion exercises do not adversely affect adequately stabilized fractures and are cost-effective interventions with significant impact on preventing the most functionally disabling complication: finger stiffness 1
- Instruct patients to move uninvolved fingers regularly through complete range of motion, as finger stiffness can be extremely difficult to treat after fracture healing and may require multiple therapy visits or additional surgical intervention 1
When Surgical Intervention Is Needed
- Consider surgical fixation if displacement exceeds 3mm, though this is uncommon in tuft fractures 1
- Volar articular fractures with flexor digitorum profundus tendon avulsion require surgical replacement 3
- Non-union, while rare in tuft fractures, may require open reduction and Kirschner wire fixation 4, 5
Follow-up Protocol
- Obtain radiographic evaluation at approximately 3 weeks post-immobilization to assess healing 1
- Perform final radiographic confirmation at the time of immobilization removal 1
- Monitor for immobilization-related complications (skin irritation, muscle atrophy), which occur in approximately 14.7% of cases 1
Common Pitfalls to Avoid
- Do not over-immobilize uninvolved joints, as the American Academy of Orthopaedic Surgeons emphasizes that excessive immobilization leads to stiffness requiring extensive rehabilitation 1
- Do not delay instruction on finger motion exercises—this should occur at the initial visit 1
- Ensure adequate soft tissue care, as tuft fractures are crush injuries with significant surrounding tissue damage 3