Information for Family Member: Possible Subtle Fracture at Base of Proximal Phalanx, Left Fourth Finger
Immediate Next Steps
Your relative needs a standard 3-view X-ray of the hand (posteroanterior, lateral, and oblique views) as soon as possible to confirm whether a fracture is present. 1
- An internally rotated oblique projection in addition to the standard externally rotated oblique increases the chance of detecting phalangeal fractures that might be missed on standard views 1
- Two views alone are inadequate for detecting finger fractures—three views are the standard of care 1
- If X-rays are negative but clinical suspicion remains high (persistent pain, swelling, inability to use the finger), the finger should be splinted and X-rays repeated in 10-14 days, though this delays diagnosis 1
What to Expect Based on X-ray Results
If Fracture is Confirmed and Stable (Non-displaced or Minimally Displaced)
Most base fractures of the proximal phalanx can be treated conservatively with buddy taping to the adjacent finger and immediate mobilization, which produces excellent functional outcomes. 2
- Buddy tape the fourth finger to the third finger for support 2
- Immediate mobilization (gentle movement) is encouraged rather than rigid immobilization to prevent joint stiffness 2, 3
- For more unstable fractures, a dorsopalmar splint may be used with the wrist dorsiflexed 30 degrees and the knuckle (metacarpophalangeal joint) flexed 70-90 degrees—this "intrinsic plus position" stabilizes the fracture while allowing finger joint movement 3
- Healing typically takes 4-6 weeks 4
If Fracture Requires Surgical Referral
Immediate orthopedic referral is needed if X-rays show:
- Angulation greater than 10 degrees 4
- Significant displacement of bone fragments 4
- Rotational deformity (finger doesn't line up properly with others when making a fist) 4, 5
- Unstable fracture that cannot maintain position after closed reduction 5, 6
Critical Warning Signs
Return immediately or call the treating physician if:
- Finger appears rotated compared to other fingers when making a fist 5
- Increasing pain that doesn't improve with ice and elevation
- Numbness or tingling develops
- Finger turns pale, blue, or cold
Pain Management During Initial Phase
- Apply ice wrapped in a thin towel for 10-20 minutes at a time to reduce swelling 7
- Over-the-counter pain medication (acetaminophen or ibuprofen) as directed
- Elevate the hand above heart level when resting
- Do not apply heat 7
Common Pitfalls to Avoid
- Do not skip the X-ray even if pain is mild—subtle fractures at the base of the proximal phalanx can be missed clinically and lead to long-term stiffness or deformity if untreated 1
- Do not accept only 2 X-ray views—insist on the standard 3-view examination including oblique projections 1
- If treated conservatively with buddy taping, do not keep the finger completely immobilized—early gentle movement of the finger joints prevents permanent stiffness 2, 3
- Watch carefully for rotational malalignment (finger pointing wrong direction when bent)—this requires surgical correction 4, 5
Expected Outcomes
- With appropriate treatment, 86% of patients achieve full range of motion 3
- Conservative treatment with buddy taping and immediate mobilization shows high patient satisfaction with minimal complications 2
- Nonunion (failure to heal) is rare with proper treatment 2, 3
- Most patients return to normal grip strength 6