Treatment of Nondisplaced Fracture of the 4th Distal Phalanx
Conservative management with protective splinting is the appropriate treatment for nondisplaced distal phalanx fractures, as these injuries rarely require specific fracture treatment and heal well with immobilization and soft tissue care. 1
Initial Management Approach
Immobilization with protective splinting is the standard of care for nondisplaced distal phalanx fractures 1, 2. These fractures typically occur from crushing mechanisms and the primary focus should be on managing surrounding soft tissue injuries rather than the fracture itself 1.
Specific Treatment Protocol
- Apply a protective splint to the affected digit for approximately 3 weeks 3
- Initiate active finger motion exercises immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling complications 3
- Obtain radiographic follow-up at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 3
Critical Assessment Points
Before proceeding with conservative management, you must exclude specific injury patterns that require surgical intervention:
- Evaluate for palmar articular fractures with associated flexor digitorum profundus tendon avulsion, which require surgical repair 1, 4
- Assess for displacement of the distal phalanx or interfragmentary gap >3 mm, which indicates need for operative fixation 5
- Check for articular involvement exceeding one-third of the joint surface, which typically requires surgical management 5
Common Pitfalls to Avoid
Do not miss associated tendon injuries. Nondisplaced fractures can mask significant flexor or extensor tendon avulsions that require surgical treatment 4. The case literature documents missed diagnoses when clinicians focus solely on the nondisplaced fracture appearance on radiographs 4.
Monitor for immobilization-related complications including skin irritation and muscle atrophy, which occur in approximately 14.7% of cases 3. This is particularly relevant for digit immobilization where stiffness can significantly impact hand function.