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

Abstract

Title

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

Background

Proximal phalangeal fractures are common yet challenging due to their inherent instability and intimate relationship with surrounding soft tissue. Although traditionally managed surgically, conservative orthotic management of extra-articular (including those ‘initially unstable’) proximal phalanx fractures has been recommended. Local anaesthetic and manipulation (LAMP) is performed as required. While conservative management is safe and effective for many, a small number (up to 8.7%) fail.

Problem

For patients that ‘fail’ conservative management (lose anatomical alignment), is a second LAMP possible or should they automatically convert to surgery? We faced this dilemma with a patient that lost reduction one week following LAMP.

Intervention

Keen to avoid surgery, patient M requested a second LAMP (LAMP2) rather than conversion to surgery. Consultation between patient-therapist-surgeon resulted in LAMP2 and continuation of conservative management with a custom-fabricated hand-based thermoplastic orthosis. This was unique in that we were unable to identify any cases of two LAMP procedures a week apart having been previously reported.

Evaluation

Outcomes collected at baseline, 6, 12 and 15 weeks and 10 months following LAMP2 showed by 12 weeks, full range of motion, minimal pain, no difficulty with personal daily activities, and full manual labour work duties and gym workouts had resumed. Quality of life was reported ‘high’ from 6 weeks and M reported he was extremely satisfied and would undergo the treatment again.

Recommendations

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.