Conservative Treatment of Fractures of the Proximal Phalanx: An Option Even for Unstable Fracture Patterns

PURPOSE: The purpose of the study was to assess the efficacy of the conservative management of proximal phalangeal fractures in a dorsal plaster slab. METHODS: Twenty-three consecutive patients with extra-articular proximal phalangeal fractures were included in this prospective study. Fourteen patients (62%) presented with fractures considered unstable. The fractures were reduced and the position was held with a dorsal plaster slab for three weeks. The patients were followed up for an average of seven weeks (range 2 to 45) after the injury. Range of motion of the finger and radiological evidence of union, non-union or malunion was documented after removal of the plaster. RESULTS: Ninety-one percent of fractures maintained an acceptable reduction. All cases measured less than 15° of angulation. On average 1,1 mm of shortening was measured. In two (9%) cases the reduction was not accepted on follow up assessment and the fractures were managed surgically. CONCLUSION: Most extra-articular proximal phalanx fractures can be managed conservatively with acceptable results.