Treatment of Open Tuft Fracture of the Distal Phalanx

Initial Assessment and Management

Radiography is essential as the initial imaging, with at least 3 views recommended to properly evaluate the fracture pattern and associated injuries, according to the American College of Radiology 1
For distal phalanx fractures, radiographs should assess the degree of displacement, articular involvement, and associated soft tissue injuries, as recommended by the American Academy of Orthopaedic Surgeons 2
Open fractures require thorough irrigation and debridement to prevent infection, as indicated by the American Academy of Orthopaedic Surgeons 2
Antibiotic prophylaxis is indicated for all open fractures to reduce infection risk, according to the American Academy of Orthopaedic Surgeons 2

Rigid immobilization with a splint for 3-6 weeks is indicated for most tuft fractures, as these rarely require surgical intervention, as stated by the American Academy of Orthopaedic Surgeons 2
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 3
Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing, as reported by the American Academy of Orthopaedic Surgeons 3

Surgery should be considered only when there is significant displacement (>3mm), involvement of more than one-third of the articular surface, palmar displacement of the distal phalanx, or interfragmentary gap of >3mm, as recommended by the American Academy of Orthopaedic Surgeons 2

A home exercise program is an effective option for patients after fracture immobilization, as stated by the American Academy of Orthopaedic Surgeons 3
Instructing the patient to move the fingers regularly through a complete range of motion helps minimize the risk of stiffness complications, according to the American Academy of Orthopaedic Surgeons 3
Unremitting pain during follow-up warrants reevaluation, as this may indicate complications, as reported by the American Academy of Orthopaedic Surgeons 3, 2

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 3
Overlooking displacement or articular involvement can lead to poor functional outcomes, as cautioned by the American Academy of Orthopaedic Surgeons 2