From the Guidelines
The treatment for an open fracture of the distal phalanx of the left 5th toe in an 8-year-old child should involve irrigation with saline solution and early antibiotic administration, with a consideration for definitive fixation and primary closure if appropriate, and surgical débridement should be performed as soon as reasonable, ideally before 24 hours post-injury.
Initial Management
- The initial wound management should include irrigation with saline solution (without additives), as recommended by the American Academy of Orthopaedic Surgeons with a strong strength of recommendation 1.
- Antibiotics should be administered early, with options including cefazolin or clindamycin, and consideration for adding gram-negative coverage with an aminoglycoside for more severe open fractures 1.
Surgical Timing
- Surgical débridement should be performed as soon as reasonable, ideally before 24 hours post-injury, with a moderate strength of recommendation 1.
Definitive Fixation and Primary Closure
- Definitive fixation of the fracture and primary closure of the wound may be considered in selected patients, but no single favored treatment was observed, with a moderate strength of recommendation 1.
- Temporizing external fixation remains a viable option for the treatment of open fractures in major extremity trauma, with a moderate strength of recommendation 1.
From the Research
Treatment Options for Open Fracture of the Distal Phalanx
The treatment for an open fracture of the distal phalanx of the left 5th toe in an 8-year-old child may involve various approaches, considering the type of fracture and the surrounding soft tissues.
- The therapy must be done under consideration of fracture type and soft tissues 2.
- Open physeal fractures of the distal phalanx can result in long-term sequelae, including infection, pain, nail deformity, and physeal arrest if missed or not properly treated 3.
- Suture-only stabilization represents a simple, reliable alternative to pin fixation for open physeal fractures of the distal phalanx 3.
- For stubbed great toe injuries with signs of a displaced fracture through the physis of the distal phalanx, an effective treatment algorithm should be applied to guide management 4.
Surgical Interventions
Surgical interventions may be necessary for certain cases, such as:
- Open reduction and Kirschner wire (K-wire) stabilization for Salter-Harris I fracture involving the distal phalanx of the great toe 4.
- Surgical fixation and inter-phalangeal arthrodesis for symptomatic non-union of fracture of a lesser toe distal phalanx 5.
- Open reduction and interfragmentary screw fixation for symptomatic nonunion of distal phalangeal fractures 6.
Considerations
It is essential to consider the mechanism of injury, fracture type, and surrounding soft tissues when determining the appropriate treatment approach 2, 3, 4.