Undisplaced, or minimally displaced, fractures of the diaphysis of the
proximal phalanx can be treated nonoperatively.
Most of these fractures produce an extension deformity and minimal
shortening. If the extension deformity exceeds 15-20 degrees, operative
treatment is recommended. More than 2 mm shortening can not be accepted.
Undisplaced metaphyseal and articular fractures may also be treated
Irreducible rotational malalignment is an indication for operative
AO teaching video: Extension block splint (Burke Halter)
Displacement usually occurs as an extension
Reduction is achieved by applying longitudinal traction to the finger and
flexing the MCP joint.
Rotational malalignment is also corrected.
Any lateral angulation can be checked by comparison with the adjacent fingers,
and must be reduced.
Check angular reduction using image intensification.
In undisplaced fractures, a splint may be applied with the hand in an
intrinsic plus (Edinburgh) position and the wrist in slight extension of 20-30
In compliant patients, only the fractured finger ray and the two adjacent
rays are included in the splint.
The splint is held in place with an elastic bandage. The bandage should not be
overtightened at the level of the wrist joint, in order to avoid excessive
swelling of the hand.
Direct skin contact of adjacent fingers should be prevented by placing gauze
pads between them.
This splint is easy to apply and needs no hand therapy during the period of
immobilization. A potential disadvantage of this technique is the complete
immobilization of uninjured fingers and joints.
A standard forearm cast is applied, including the wrist joint in 30 degrees
of extension, and the aluminium splint is incorporated in the cast. This
aluminium splint must be pre-bent to 90 degrees proximal to the level of the
MCP joint of the injured finger. The finger is taped to this splint in an
intrinsic plus position. Correct rotational alignment must be checked. The
other fingers are not immobilized.
The cast must only be applied once the initial swelling has abated, usually
a few days after the injury.
Correct bending of the aluminium splint and correct fixation of the splint
in the cast are difficult but essential. The bend for the flexion of the MCP
joint is more proximal than often perceived. There is a risk of excessive
pressure and later ulceration of the soft tissues at the level of the bend if
it is too distal.
The advantage of this technique is that only the injured finger is
immobilized. Usually hand therapy is not necessary.
Another advantage is that this technique helps maintain length in shortened
fractures, but there is less control over rotation than with immobilisation of
the adjacent rays (Option 1).
This splint comprises 3 parts:
- A dorsal splint maintaining the wrist in 30 degrees of extension and the
MCP joints in full flexion, reaching distally to the PIP joints
- A palmar splint supporting the wrist in 30 degrees of extension, reaching
the distal flexion crease of the palm
- A “buddy splintage,” or strapping (syndactylisation), applied at the middle
This technique allows immediate mobilization of the interphalangeal joints
of all fingers. Its application, however, is difficult, and correct exercising
must be supervised by a hand therapist. “Buddy splintage,” prevents rotational