Northwestern University Feinberg School of Medicine

Orthopedic Teaching

Hand Case 6 ED Management

Proximal phalanx fracture


ED Management

Conservative treatment of stable, non-displaced fractures (approximately 75%) is buddy taping. Displaced or unstable fractures are not suitable for dynamic splinting and should have gutter splinting. Cases appropriate for conservative treatment have <5mm shortening, <15 degrees angulation, and normal rotation. Immobilization should not exceed 3 weeks to prevent stiffness.

Fractures with rotational deformity and displaced midshaft transverse, spiral oblique, and intraarticular fractures are more unstable and require reduction, which is often difficult. Surgical intervention is required when reduction fails, when there is fracture comminution, or to facilitate return to sports.

Repeat radiographs in one week are recommended to ensure that there is no interval displacement.