Patient-centered care in the conservative management of an unstable proximal phalanx fracture: A case report.

Abstract

Background: Proximal phalangeal fractures are common yet challenging due to their inherent instability.

Purpose: This study presents a case for patient-centered care and a nonsurgical management pathway.

Study design: Case report.

Methods: M, a 56-year-old male, sustained a comminuted oblique proximal phalanx fracture to his left nondominant small finger while playing football. Five days post injury, the fracture was reduced with local anesthetic and manipulation (LAMP). The injury was managed conservatively with a full-time hand-based orthosis with metacarpophalangeal joint flexion, and buddy taping. One week later, the fracture had lost reduction and significantly displaced. Instead of converting to surgery, a further LAMP (LAMP2) was performed, and conservative management continued. Outcomes were collected at baseline, 6, 12, and 15 weeks, and 10 months following LAMP2.

Results: By 12 weeks, M had a full range of motion, minimal pain, no difficulty with personal daily activities, and resumed full manual labor work duties and gym workouts. Quality of life was reported as high from 6 weeks. M was extremely satisfied.

Conclusions: Conservative management of an initially unstable proximal phalanx reduced by LAMP, with a second LAMP one week later, demonstrated excellent outcomes and could be a possible management pathway for similar patients.