Author disclosure: No relevant financial affiliations. Pediatr Emerg Care, 2008. Most displaced fractures of the lesser toes can be managed by family physicians if there are no indications for referral. Copyright 2023 American Academy of Family Physicians. A Jones fracture has a higher risk of nonunion and requires at least six to eight weeks in a short leg nonweight-bearing cast; healing time can be as long as 10 to 12 weeks. Comminution is common, especially with fractures of the distal phalanx. Type in at least one full word to see suggestions list, 2022 California Orthopaedic Association Annual Meeting, COA Foot and Ankle End - Glenn Pfeffer, MD, Comminuted Fifth Metatarsal Fracture in 28M. Illustrations of proximal interphalangeal joint (PIPJ) fracture-dislocation patterns. What is the optimal treatment for the proximal phalanx fracture shown in Figure A? Magnetic Resonance Imaging (MRI) scans. On exam, he is neurovascularly intact. Surgeons will learn to assess and evaluate phalangeal anatomy and fracture geometry. Lightly wrap your foot in a soft compressive dressing. Patients with circulatory compromise require emergency referral. Most fractures can be seen on a routine X-ray. Patients usually present with a painful, swollen, ecchymotic toe with variable deformity and gait disturbance. Most broken toes can be treated without surgery. 11(2): p. 121-3. Tarsal phalanges fractures - OrthopaedicsOne Articles (OBQ05.226) Ribbans, W.J., R. Natarajan, and S. Alavala, Pediatric foot fractures. Copyright 2023 Lineage Medical, Inc. All rights reserved. Analytical, Diagnostic and Therapeutic Techniques and Equipment 43. Nondisplaced or minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts with less than 10 of angulation can be treated conservatively with a short leg walking boot, cast shoe, or elastic bandage, with progressive weight bearing as tolerated. We help you diagnose your Hand Proximal phalanx case and provide detailed descriptions of how to manage this and hundreds of other pathologies. To minimize the possibility of future disability, the position of the bone fragments after reduction should be as close to anatomic as possible. - See: Phalangeal Injury Menu: - Discussion: - fractures of the proximal phalanx are potentially the most disabling fractures in the hand; - direct blows tend to cause transverse or comminuted frx, where as twisting injury may cause oblique or spiral fracture; - proximal fragments are usually flexed by intrinsics while distal fragments are extended due to extrinsic compressive forces; Copyright 2023 Lineage Medical, Inc. All rights reserved. Most fifth metatarsal fractures can be treated with weight bearing as tolerated, and immobilization in a cast or walking boot. The proximal phalanx is the toe bone that is closest to the metatarsals. Continue to learn and join meaningful clinical discussions . Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, He Is Playing With Nonoperative Treatment - Michael Coughlin, MD, He Is Out! hand fractures orthoinfo aaos metatarsal fractures foot ankle orthobullets phalanx fractures hand orthobullets fractures of the fifth metatarsal physio co uk 5th metatarsal . (Left) The four parts of each metatarsal. (OBQ12.89) To unlock fragments, it may be necessary to exaggerate the deformity slightly as traction is applied or to manipulate the fragments with one hand while the other maintains traction. PMID: 22465516. We help you diagnose your Toe fractures case and provide detailed descriptions of how to manage this and hundreds of other pathologies . A 34-year-old male sustains the closed finger injury shown in Figure A one week ago. The proximal phalanx is the phalanx (toe bone) closest to the leg. Reduction of fractures in children can usually be accomplished by simple traction and manipulation; open reduction is indicated if a satisfactory alignment is not obtained. Foot fractures are among the most common foot injuries evaluated by primary care physicians. In some practice sites, family physicians manage open toe fractures; a discussion about the management of this type of injury can be found elsewhere.3,4 Patients also may require referral because of delayed complications such as osteomyelitis from open fractures, persistent pain after healing, and malunion. The forefoot has 5 metatarsal bones and 14 phalanges (toe bones). Posterior splint; nonweight bearing; follow-up in three to five days, Short leg walking cast with toe plate or boot for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to six weeks, Open fractures; fracture-dislocations; intra-articular fractures; fractures with displacement or angulation, Short leg walking boot or cast for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to eight weeks, Open fractures; fracture-dislocations; multiple metatarsal fractures; displacement > 3 to 4 mm in the dorsoplantar plane; angulation > 10 in the dorsoplantar plane, Three-view foot series with attention to the oblique view, Compressive dressing; ambulate as tolerated; follow-up in four to seven days, Short leg walking boot for two weeks, with progressive mobility and range of motion as tolerated; follow-up every two to four weeks; healing time of four to eight weeks, Repeat radiography at six to eight weeks to document healing, Displacement > 3 mm; step-off > 1 to 2 mm on the cuboid articular surface; fracture fragment that includes > 60% of the metatarsal-cuboid joint surface, Short leg nonweight-bearing cast for six to eight weeks; cast removal and gradual weight bearing and activity if radiography shows healing at six to eight weeks, or continue immobilization for four more weeks if no evidence of healing; healing time of six to 12 weeks, Repeat radiography at one week for stability and at the six- to eight-week follow-up; if no healing at six to eight weeks, repeat radiography at the 10- to 12-week follow-up, Displacement > 2 mm; 12 weeks of conservative therapy ineffective with nonunion revealed on radiography; athletes or persons with high activity level, Three-view foot series or dedicated phalanx series, Short leg walking boot; ambulate as tolerated; follow-up in seven days, Short leg walking boot or cast with toe plate for two to three weeks, then may progress to rigid-sole shoe for additional three to four weeks; follow-up every two to four weeks; healing time of four to six weeks, Repeat radiography at one week if fracture is intra-articular or required reduction, Fracture-dislocations; displaced intra-articular fractures; nondisplaced intra-articular fractures involving > 25% of the joint; physis (growth plate) fractures, Buddy taping and rigid-sole shoe; ambulate as tolerated; follow-up in one to two weeks, Buddy taping and rigid-sole shoe for four to six weeks; follow-up every two to four weeks; healing time of four to six weeks, Displaced intra-articular fractures; angulation > 20 in dorsoplantar plane; angulation > 10 in the mediolateral plane; rotational deformity > 20; nondisplaced intra-articular fractures involving > 25% of the joint; physis fractures. Surgical fixation involves Kirchner wires or very small screws. If there is a break in the skin near the fracture site, the wound should be examined carefully. Displaced fractures of the first toe generally are managed similarly to displaced fractures of the lesser toes. If no healing has occurred at six to eight weeks, avoidance of weight-bearing activity should continue for another four weeks.2,6,20 Typical length of immobilization is six to 10 weeks, and healing time is typically up to 12 weeks. (Kay 2001) Complications: Phalangeal fractures are very common, representing approximately 10% of all fractures that present to the emergency room. Most patients have point tenderness at the fracture site or pain with gentle axial loading of the digit. The injured toe should be compared with the same toe on the other foot to detect rotational deformity, which can be done by comparing nail bed alignment. A 19-year-old cross country runner complains of 3 months of foot pain with running. Physical examination should include assessment of capillary refill; delayed capillary refill may indicate circulatory compromise. A 26-year-old professional ballet dancer presents with insidious onset of right midfoot pain which began 6 months ago. 9(5): p. 308-19. Your doctor will tell you when it is safe to resume activities and return to sports. Proximal phalangeal fractures - Melbourne Hand Surgery They are common in runners and athletes who participate in high-impact sports such as soccer, football, and basketball. Foot Fractures - Phalanx | Pediatric Orthopaedic Society of - POSNA This usually occurs from an injury where the foot and ankle are twisted downward and inward. To check proper alignment, radiographs should be taken immediately after reduction and again seven to 10 days after the injury (three to five days in children).4 In patients with potentially unstable or intra-articular fractures of the first toe, follow-up radiographs should be taken weekly for two or three weeks to monitor fracture position. All the bones in the forefoot are designed to work together when you walk. At the first follow-up visit, radiography should be performed to assure fracture stability. Fracture position ideally will be maintained when traction is released, but in some cases the reduction can be held only with buddy taping. toe phalanx fracture orthobullets - glossacademy.co.uk Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks. Patients should be instructed to apply ice, elevate the foot above heart level, and use analgesics as needed. Nondisplaced fractures usually are less apparent; however, most patients with toe fractures have point tenderness over the fracture site. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. Bite The Bullet, He Needs Long Term Function: Be The Hated Person - Robert Anderson, MD. Rotator Cuff and Shoulder Conditioning Program. Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Physicians should consider referring patients with fractures of the great toe that have any degree of displacement, angulation, or rotational deformity 6,24 (Figure 12). Toe and forefoot fractures often result from trauma or direct injury to the bone. Returning to activities too soon can put you at risk for re-injury. Which of the following acute fracture patterns would best be treated with open reduction and internal fixation? myAO. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Patients with intra-articular fractures are more likely to develop long-term complications. Evaluation and Management of Toe Fractures | AAFP Although referral rarely is required for patients with fractures of the lesser toes, referral is recommended for patients with open fractures, fracture-dislocations (Figure 5), displaced intra-articular fractures, and fractures that are difficult to reduce. The younger the child, the more . You can rate this topic again in 12 months. Referral is indicated in patients with circulatory compromise, open fractures, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or fractures of the first toe that are unstable or involve more than 25 percent of the joint surface. Phalangeal fractures are very common, representing approximately 10% of all fractures that present to the emergency room. Patients typically present with varying signs and symptoms, the most common being pain and trouble with ambulation. Data Sources: We searched the Cochrane database, Essential Evidence Plus, and PubMed from 1900 to the present, human studies only, using the key words foot fractures, metatarsal, toe, and phalanges fractures. In an analysis of 339 toe fractures, 95% involved less than 2 mm of displacement and all fractures were managed conservatively with good outcomes.25, The most common mechanisms of injury are axial loading (stubbing) or crush injury. (OBQ18.111) Started in 1995, this collection now contains 6407 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. Dislocation refers to displacement in which the two articular surfaces are no longer in contact, in contrast to subluxation, in which there is some contact (may be referred to as complete versus simple dislocation in some texts). Treatment Most broken toes can be treated without surgery. Some metatarsal fractures are stress fractures. ROBERT L. HATCH, M.D., M.P.H., AND SCOTT HACKING, M.D. See permissionsforcopyrightquestions and/or permission requests. Referral should be strongly considered for patients with nondisplaced intra-articular fractures involving more than 25 percent of the joint surface (Figure 4).4 These fractures may lose their position during follow-up.
