Phalanx fracture

Info

Fracture of the toe can be broadly classed into lesser toes or great toe fractures.

Management of closed toe phalanx fractures varies depending on:

1. great toe or less toes fracture

2. joint involvement

3. undisplaced vs displaced

4. stability (whether reduction maintains)

Clinical evaluation

Particularly look for

• deformity (rotational / angular / dislocation)

• open injury that communicate with the fracture

• nail injury / subungual haematoma

• circulatory compromise

XR (AP, oblique) is indicated for great toe injuries or lesser toe injuries with deformity.

Look carefully for

• displacement (angulation / rotation / shortening).

• dislocation

• joint involvement

A&E management

Undisplaced lesser toe fractures

• these do not require x-ray (clinical diagnosis is often sufficient)

• treat with buddy strapping for comfort (remove when pain resolved)

• advise patient to wear firm-soled shoes (a walking boot can be offered), elevate, ICE and take simple over-the-counter analgesia

• these fracture usually heal well, therefore no follow up is required (DO NOT refer to VFC)

Displaced lesser toe fractures

• reduce fracture under ring block, and apply buddy taping

• post reduction check XR

• if fracture reduction well maintained on XR - then no follow up is required

• if still displaced - then refer to VFC

Undisplaced great toe fractures

• undisplaced extraarticular fracture can be as per "lesser toe injuries" (above)

• if intraarticular fracture involves >25% of the joint surface - then refer to VFC

Displaced great toe fractures

• reduce fracture under ring block, and apply buddy taping

• post reduction check XR

• if still displaced or intraarticular - then refer to VFC