treatment of phalangeal fracture

Last reviewed 01/2018

Undisplaced fractures are usually managed by "neighbour strapping" - the damaged finger is strapped to its neighbour and movement encouraged. The adjacent fingers should not be strapped too tightly so as to permit for the inevitable swelling which accompanies fracture. A small piece of an absorbable material such as felt may be placed between the two fingers to reduce skin irritation from sweating. The elastic strapping is retained for 2-3 weeks but the fracture should be reviewed during this period for possible displacement.

Displaced fractures must be first be reduced. The affected finger is pulled straight and the fracture fragments manipulated into position. Any rotational deformity must be corrected, and is easily examined by checking that:

• on flexing the fingers into the palm, all the tips converge to the scaphoid
• the fingernails are all in the same plane

The affected finger is splinted in flexion for about 3 weeks, and functionally strapped to a neighbour for a further 3 weeks.

Unstable fractures usually require internal fixation - either using screws or crossed Kirschner wiring.