Management of Nondisplaced Distal Tuft Fractures
Yes, a nondisplaced distal tuft fracture requires finger splinting, specifically immobilization of the distal interphalangeal (DIP) joint for 4-6 weeks to ensure proper healing and prevent complications. 1
Splinting Protocol
Rigid splinting of the DIP joint is necessary for uncomplicated distal phalanx fractures caused by crush injuries to the fingertip. 1 The splint should:
- Immobilize only the DIP joint while allowing proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint motion 2
- Be padded and comfortably tight but not constrictive 2
- Continue for 4-6 weeks with radiographic follow-up 1
Rationale for Immobilization
While some finger fractures can be managed with buddy taping alone, distal tuft fractures represent a distinct injury pattern. These crush injuries to the fingertip require specific DIP joint immobilization to:
- Protect the healing bone and surrounding soft tissue 1
- Prevent displacement during the healing process 1
- Allow proper tissue regrowth, which typically takes 27.5 ± 8.8 days 3
Active Motion for Unaffected Joints
Critically important: Begin active finger motion exercises immediately for all unaffected joints (PIP and MCP joints) to prevent finger stiffness. 2 The American Academy of Orthopaedic Surgeons emphasizes that:
- Finger motion does not adversely affect adequately stabilized fractures 2
- Delayed motion increases the risk of hand stiffness, which can be very difficult to treat after fracture healing 2
- Hand stiffness may require multiple therapy visits and possibly surgical intervention if prevention is neglected 2
Follow-Up and Transition
- Obtain radiographic follow-up at approximately 3 weeks to assess healing 2
- Continue rigid splinting for the full 4-6 week period 1
- Transition to aggressive finger and hand motion exercises when immobilization is discontinued 2
Common Pitfalls to Avoid
Over-immobilization of unaffected joints is a critical error. 2 Specifically:
- Never immobilize the PIP or MCP joints for a distal tuft fracture 2
- Failure to encourage immediate active mobilization of unaffected joints leads to severe stiffness that is entirely preventable 4
- Inadequate initial radiographs (only two views) are insufficient; obtain three views including oblique projections 2