From the Guidelines
The treatment for a fracture at the base of the 5th proximal phalanx typically involves immobilization with buddy taping to the adjacent 4th finger for 3-4 weeks, as this location is considered high-risk for nonunion or delayed union 1. For stable, non-displaced fractures, conservative management is usually sufficient.
- Apply the buddy tape with gauze between the fingers to prevent skin maceration, and secure it firmly but not too tightly to allow for proper circulation.
- Over-the-counter pain medications such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can help manage pain and inflammation.
- Ice the area for 15-20 minutes several times daily for the first 48-72 hours to reduce swelling.
- Elevate the hand above heart level when possible. For displaced fractures, intra-articular fractures, or those with rotational deformity, orthopedic consultation is necessary as surgical fixation with K-wires or screws may be required, considering the high-risk nature of this fracture location 1. After the immobilization period, gentle range-of-motion exercises should be initiated to prevent stiffness. This conservative approach is effective because the 5th digit has good functional compensation from adjacent fingers, and most fractures in this location heal well with proper alignment and immobilization, although the base of the 5th metatarsal is specifically highlighted as a high-risk area for complications if not properly managed 1.
From the Research
Treatment Options for Fracture at Base of 5th Proximal Phalanx
- Non-operative management: Studies have shown that non-operative management can be effective in treating fractures at the base of the 5th proximal phalanx. A study published in 2024 2 found that 80% of patients who underwent non-operative management achieved excellent or good outcomes. Another study published in 2014 3 found that buddy taping and immediate mobilisation can be an effective treatment option, with high overall satisfaction and minimal complications.
- Operative management: Operative management, including Kirschner wires (K-wires), plates, and intramedullary screws, can also be effective in treating fractures at the base of the 5th proximal phalanx. The same study published in 2024 2 found that 79% of patients who underwent K-wire fixation achieved excellent or good outcomes. However, the study also noted that plate fixation was associated with a higher rate of complications, including complex regional pain syndrome.
- Conservative treatment: Conservative treatment, including dorsal plaster slab immobilisation, can also be an effective option for treating fractures at the base of the 5th proximal phalanx. A study published in 2013 4 found that 91% of fractures maintained an acceptable reduction, and all cases measured less than 15° of angulation.
Key Considerations
- The goal of treatment is to allow for fracture healing to occur in acceptable alignment while maintaining gliding motion of the extensor and flexor tendons 5.
- Stable fractures can be successfully treated non-operatively, whereas unstable injuries may benefit from surgery 5.
- Early functional treatment, including protective dynamic splinting techniques and fiberglass casting material, can be an effective treatment option for pediatric patients with fractures of the proximal phalanx 6.