What are the discharge instructions for a 9-year-old male with a non-displaced fracture of the proximal phalanx of the 5th toe on the right foot?

From the Guidelines

For a nine-year-old male with a non-displaced fracture of the proximal phalanx of the right foot's 5th toe, discharge instructions should prioritize pain management, protection, and monitoring for complications, with a focus on rest, ice, and elevation to reduce swelling and pain. The child should avoid sports and high-impact activities for 3-4 weeks while the fracture heals.

• Buddy-taping the injured toe to the adjacent 4th toe using medical tape with gauze between the toes may be useful to reduce pain and facilitate transport to a medical facility, as splinting of a fractured extremity can be useful to reduce pain, reduce risk for further injury, and facilitate transport to a medical facility 1.
• Pain can be managed with children's acetaminophen (10-15 mg/kg every 4-6 hours as needed) or children's ibuprofen (5-10 mg/kg every 6-8 hours with food) for the first few days.
• The child should wear wide, comfortable shoes that don't put pressure on the toe, and can bear weight as tolerated if it's not too painful.
• Ice can be applied for 15-20 minutes several times daily for the first 48-72 hours to reduce swelling, with a thin cloth between the ice and skin.
• Parents should seek immediate medical attention if the child develops increased pain, swelling, numbness, skin color changes, or fever, as a fractured extremity that is blue, purple, or pale requires immediate activation of the emergency response system 1.
• A follow-up appointment should be scheduled in 2-3 weeks to ensure proper healing. These measures provide adequate support for this type of fracture, which typically heals well in children due to their excellent bone remodeling capacity.

From the Research

Discharge Instructions for a Nine-Year-Old Male with Proximal Phalynx Fracture

• The patient should be advised to elevate the affected foot to reduce swelling and pain 2, 3.
• A non-surgical, conservative protocol with immediate mobilization can be used for patients with isolated stable proximal phalangeal fractures without uncorrectable finger rotation or fracture angulation exceeding 25° in the sagittal plane or 10° in the coronal plane following closed reduction 2.
• The goal of proximal phalangeal fracture management is to allow for fracture healing to occur in acceptable alignment while maintaining gliding motion of the extensor and flexor tendons 3.
• Early functional treatment of proximal phalanx fractures in children can be achieved through nonsurgical treatment using protective dynamic splinting techniques and fiberglass casting material 4.
• The patient should be instructed to avoid bearing weight on the affected foot and to use crutches or a walker if necessary 3, 5.
• The patient should be advised to follow up with their doctor for regular check-ups to monitor the healing progress of the fracture 2, 4.
• Pain management can be achieved through over-the-counter pain medications such as acetaminophen or ibuprofen 3, 5.
• The patient should be instructed on how to properly care for the affected foot, including keeping it clean and dry, and avoiding strenuous activities 2, 6.

Follow-up Care

• The patient should be scheduled for a follow-up appointment with their doctor to remove any casting or splinting material and to assess the healing progress of the fracture 2, 4.
• The patient should be advised to continue to elevate the affected foot and to avoid bearing weight on it until the fracture has fully healed 3, 5.
• The patient should be instructed on how to perform exercises to maintain range of motion and strength in the affected foot 2, 6.