Executive Editor: Joseph Schatzker, Richard Buckley

Authors: Michael Castro, Richard Buckley, Andrew Sands, Christina Kabbash

Phalanges - 2nd-5th row, proximal phalanx, head, small fragment

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1 Indication for nonoperative treatment top

If it is a closed injury and there is no serious displacement,  the toe is best treated by strapping it to the adjacent uninjured toe (buddy taping).

Surgical stabilization is necessary when the fractures are open or grossly displaced.

2 Patient positioning top


Supine position

The patient is placed supine on a radiolucent table. A well-padded bump is placed under the ankle and heel of the surgical foot to elevate the foot for improved access and stabilize against rotation.


The nonoperative leg is secured with safety straps or taping.

To correct for external rotation of the leg and foot, a well-padded bump may be placed under the ipsilateral hip (a).

Alternatively, to correct for internal rotation of the leg and foot, a well-padded bump is placed under the contralateral hip (b).

3 Reduction top


If a toe is dislocated, it is reduced by exaggerating the deformity and then applying traction and reversing the mechanism of injury.

4 Treatment top


Alignment can be maintained by buddy taping. The skin is cleaned with alcohol to remove oils and 5-10 mm wide straps are fixed in a loop around the toes. Gauze may be placed between the toes to avoid maceration of the skin.
The MTP joint must be immobilized in an anatomical position to avoid a dorsiflexion contracture.

v2.0 2017-03-23