Management of Comminuted Distal Phalanx Fracture of the Fourth Finger

Initial Assessment and Imaging

Radiography is essential as the initial imaging for suspected finger fractures, with at least 3 views recommended to properly evaluate the fracture pattern, according to the American College of Radiology 1, 2
For distal phalanx fractures, radiographs should assess the degree of displacement 3, articular involvement 1, and associated soft tissue injuries 3

Rigid immobilization with a splint for 3-6 weeks is indicated for minimally displaced comminuted fractures, as recommended by Praxis Medical Insights 3
Active finger motion exercises should be performed following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects, according to the American Academy of Orthopaedic Surgeons 4, 5

Surgery should be considered when fracture fragment displacement is greater than 3mm 1, involvement of more than one-third of the articular surface 1, palmar displacement of the distal phalanx 1, or interfragmentary gap of >3mm 1

Hand stiffness is one of the most functionally disabling adverse effects following fracture treatment, as noted by the American Academy of Orthopaedic Surgeons 6
A home exercise program is an effective option for patients after fracture immobilization, according to the American Academy of Orthopaedic Surgeons 5, 7
Instructing the patient to move the fingers regularly through a complete range of motion helps minimize the risk of stiffness complications, as recommended by the American Academy of Orthopaedic Surgeons 6
Finger motion does not have adverse effects on an adequately stabilized fracture in regard to reduction or healing, according to the American Academy of Orthopaedic Surgeons 6

Unremitting pain during follow-up warrants reevaluation, as this may indicate complications, as noted by the American Academy of Orthopaedic Surgeons 5 and Praxis Medical Insights 8
Patients should be monitored for proper fracture healing 7, restoration of finger function 3, development of stiffness 7, and persistent pain 3, 8

Failure to encourage early finger motion can lead to significant stiffness that is difficult to treat after fracture healing, as warned by the American Academy of Orthopaedic Surgeons 6
Overlooking displacement or articular involvement can lead to poor functional outcomes, according to Praxis Medical Insights 3