Treatment of Comminuted and Mildly Displaced Small Finger Proximal Phalanx Fracture

Initial Imaging Assessment

The American College of Radiology recommends obtaining at least 3-view radiographs (posteroanterior, lateral, and oblique) of the affected finger to properly evaluate the fracture pattern, degree of displacement, and articular involvement 2
Standard 2-view radiography is inadequate for detecting all fracture characteristics in finger injuries, according to the American College of Radiology 2

The recommended treatment approach for a comminuted and mildly displaced small finger proximal phalanx fracture is rigid immobilization in an intrinsic-plus position for 3-6 weeks combined with immediate active interphalangeal joint motion exercises, as suggested by the American College of Orthopaedic Surgeons 1
Fracture fragment displacement >3mm, involvement of more than one-third of the articular surface, and interfragmentary gap >3mm are indications for surgical referral, according to the American Academy of Orthopaedic Surgeons 1, 4
Malrotation detected on clinical examination is also an indication for surgical referral, as recommended by the American College of Orthopaedic Surgeons 3

The American College of Orthopaedic Surgeons recommends examining finger alignment during active flexion to assess for malrotation, by having the patient actively flex all fingers together into a fist 3
Scissoring, where the small finger crosses over or under the ring finger, is a hallmark sign of rotational malalignment requiring immediate intervention, according to the American College of Orthopaedic Surgeons 3

The American Academy of Orthopaedic Surgeons recommends obtaining repeat radiographs at 10-14 days to ensure fracture position is maintained, and continuing radiographic monitoring for 3 weeks and at cessation of immobilization 3, 5
A home exercise program is effective for patients after fracture immobilization, and instructing the patient to move the fingers regularly through complete range of motion can minimize stiffness risk, as suggested by the American College of Orthopaedic Surgeons 1