Management of Comminuted Fracture of Proximal Phalanx of Big Toe

Initial Management

Immobilize the fractured toe in the position found to reduce pain, prevent further injury, and facilitate transport to a medical facility 1
Cover any open wounds associated with the fracture with a clean dressing to reduce risk of contamination and infection 1
If the fractured toe appears blue, purple, or pale, activate emergency medical services immediately as this indicates poor perfusion 1
Do not attempt to straighten a deformed fracture unless necessary for safe transport 1
Overtightening a compression wrap can compromise circulation 1

Use a rigid splint that immobilizes the fracture site while allowing for motion of unaffected joints 2
The splint should extend beyond the fracture site to include adjacent joints for stability 3
For toe fractures, buddy taping to an adjacent uninjured toe can provide adequate support and immobilization 3
Padding should be placed between the toes to prevent skin maceration 3

CT imaging may be needed to fully assess the extent of comminution and intra-articular involvement 4
MRI can be useful if there is concern for associated soft tissue injuries 4

Immobilization should be maintained until clinical and radiographic evidence of healing 2
Radiographic follow-up is typically recommended at approximately 3 weeks 2
Total immobilization time varies based on fracture severity, but typically ranges from 3-6 weeks 2

Early motion of unaffected joints should be encouraged to prevent stiffness 2
Weight-bearing status should be determined based on fracture stability and healing progress 5
For stable fractures, weight-bearing as tolerated may be appropriate 5