Background: Proximal phalanx fractures account for approximately 20% of all phalangeal fractures. They are known to be challenging to treat, whether conservatively or surgically. These injuries can significantly impact hand function and patients’ quality of life if poorly managed.
Objective: A systematic review to determine the benefits and risks of conservative therapies for managing extra-articular proximal phalanx fractures to optimise patient recovery and minimise the burden of managing complications from surgical intervention.
Methods: A literature search was run on 14 September 2021 using MEDLINE, Embase, Emcare, the World Health Organization International Clinical Trials Registry Platform, the Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Studies involving adults with isolated extra-articular proximal phalanx fractures of the fingers only associated with simple lacerations or isolated digital nerve injury were included. Thumb phalanx fractures or injuries with a delayed presentation of more than 2 weeks were excluded. Article screening, data extraction, and critical appraisal using the Structured Effectiveness Quality Evaluation scale was performed independently.
Results: Seven manuscripts were included, capturing 389 fractures from 356 unique patients. Studies were of level II to IV evidence. Mean age of patients were 41.6 (range 18–93) years, with most participants being male (66.4%). Collectively a weighted mean TAM score of 249° was achieved, with 99.5% of fractures establishing union. A formal meta-analysis was not performed given the heterogeneity of the included literature.
Discussion and conclusion: Non-operative treatment of proximal phalanx fractures involving timely rehabilitation, a plaster or orthotic device, controlled metacarpophalangeal joint flexion, and free mobilisation of the interphalangeal joints are a reliable alternative to surgery. The lack of high-quality research and considerable variation between studies limits the validity and direct comparison of results. Further research is necessary to substantiate the efficacy of conservative modalities.