From the Guidelines
Surgery is the usual treatment for intraarticular 5th proximal phalanx fracture toe, but simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. When considering treatment for an intraarticular fracture of the 5th proximal phalanx of the toe, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician in 2002 1, the diagnosis is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.
Key Considerations
- The size and displacement of the fracture fragments play a crucial role in determining the treatment approach.
- Simple immobilization is suitable for small, nonarticular, or minimally displaced fractures.
- Surgery is typically recommended for more complex cases.
Treatment Approach
- For small, nonarticular, or minimally displaced fractures, immobilization can be an effective treatment option, allowing the fracture to heal while minimizing complications.
- In cases where surgery is necessary, the goal is to restore joint congruity and promote proper healing.
- Post-treatment care, including pain management and follow-up radiographs, is essential to ensure proper healing and minimize long-term disability.
Important Factors
- The American College of Foot and Ankle Surgeons' guidelines, as reported in 2002 1, emphasize the importance of considering the size and displacement of the fracture fragments when determining the treatment approach.
- While the guidelines do not provide specific details on conservative management, they do highlight the role of surgery in treating intraarticular fractures of the 5th proximal phalanx of the toe.
From the Research
Treatment Options for Intraarticular 5th Proximal Phalanx Fracture Toe
- The treatment for intraarticular 5th proximal phalanx fracture toe can vary depending on the severity and displacement of the fracture.
- Conservative management with buddy taping and immediate mobilisation has been shown to be effective in treating base fractures of the fifth proximal phalanx, with high overall satisfaction and minimal complications 2.
- Open reduction and internal fixation with a locked-wire-type external fixator, such as the Ichi-Fixator System, can be used to treat comminuted intraarticular fractures of the base of the proximal phalanx, allowing for accurate reduction and rigid internal fixation 3.
- Volar plating is another technique that can be used to treat intraarticular fractures of the base of the proximal phalanx, offering direct visualization of the volar base fragment and the depressed central fragment, and allowing for a more accurate reduction and rigid internal fixation 4.
- Transverse volar plating, also known as the Seatbelt procedure, can be used to treat unstable intra-articular proximal interphalangeal fracture-dislocations, providing congruous joint reduction and stable internal fixation 5.
Return to Sport After Treatment
- The return to sport after treatment for intraarticular 5th proximal phalanx fracture toe can vary depending on the treatment method and individual factors.
- A systematic review found that the majority of sport-related toe phalanx fractures are managed conservatively with overall satisfactory return to sport rates and times 6.
- Surgical management is indicated for displaced, intra-articular fractures, and can offer satisfactory return to sport rates and times 6.
- The review also found that surgical management is indicated for stress fractures with delayed diagnosis and established non-union at presentation, or with significant underlying deformity, and can offer satisfactory return to sport rates and times 6.