What is the treatment for an acute, mildly displaced and comminuted fracture of the distal tuft of the distal phalanx of the middle finger?

From the Guidelines

The treatment for an acute mildly displaced and comminuted fracture of the distal tuft of the distal phalanx of the middle finger primarily involves conservative management, with immobilization and pain management being key components, as supported by general principles of fracture management 1.

Key Components of Treatment

• Immobilization with a protective splint for 3-4 weeks is recommended, keeping the distal interphalangeal (DIP) joint in slight flexion to maintain function.
• Pain management should include acetaminophen 500-1000mg every 6 hours as needed, or ibuprofen 400-600mg every 6-8 hours with food if not contraindicated.
• Elevation of the hand above heart level and ice application for 15-20 minutes several times daily for the first 48-72 hours will help reduce swelling.

Additional Considerations

• The nail should be kept intact if possible as it serves as a natural splint for the fracture.
• If a subungual hematoma is present and painful, it may require drainage through the nail.
• Most tuft fractures heal well with conservative treatment within 4-6 weeks.
• Follow-up should occur at 1-2 weeks to ensure proper healing, with gentle range of motion exercises beginning after 3-4 weeks of immobilization to prevent stiffness, as early finger motion is essential to prevent oedema and stiffness 1.

Surgical Intervention

• Surgery is rarely needed for these fractures unless there is significant displacement, open fracture, or nail bed injury requiring repair.

From the Research

Treatment Options for Acute Mildly Displaced and Comminuted Fracture of the Distal Tuft of the Distal Phalanx of the Middle Finger

• The treatment for acute mildly displaced and comminuted fracture of the distal tuft of the distal phalanx of the middle finger can be either conservative or surgical, depending on the severity of the fracture and the patient's overall condition 2.
• Conservative treatment may involve the use of a mallet finger splint, while surgical treatment may involve closed reduction and osteosynthesis with Kirschner wires (K-wires) or open reduction and osteosynthesis with K-wires 2.
• The stability of the distal phalanx fracture can be influenced by the presence of the nail and the type of fixation used, with the nail providing additional stability and fixation using two crossed Kirschner wires providing more stability than fixation using a single Kirschner wire 3.
• The management of phalangeal fractures, including those of the distal phalanx, should be based on an evidence-based approach, taking into account the type of fracture, the patient's goals, and the range of motion 4.
• The type of fixation method can range from percutaneous pinning to open reduction and internal fixation, and the choice of treatment should be individualized to optimize patient outcomes 4.

Factors to Consider in Treatment

• The presence of nail loss and the type of fixation used can affect the stability of the fracture 3.
• The severity of the fracture and the patient's overall condition should be taken into account when deciding on the treatment approach 2.
• The goal of treatment should be to optimize patient outcomes, including range of motion and functional ability 4.

Potential Treatment Approaches

• Conservative treatment with a mallet finger splint may be suitable for mildly displaced fractures 2.
• Surgical treatment with closed reduction and osteosynthesis with K-wires or open reduction and osteosynthesis with K-wires may be necessary for more severely displaced or comminuted fractures 2, 3.
• Percutaneous pinning or open reduction and internal fixation may be considered as fixation methods 4.