Minimally Displaced Intra articular Avulsion Fracture seen by Doctor after One Month

Dear Ask The Doctor:  Hello Doctor, I am a 45 year old female who stubbed her toe 1 month ago. I thought it was nothing but after a month of not improving, I went to see my doctor who did an Xray which showed a minimally displaced intra articular avulsion fracture arising from the dorsal base of the distal phalanx of the right third toe. My question is: What do you recommend for management: surgery, bracing, immobilization, something else and why? What should be done for treatment monitoring? I am otherwise healthy.
 

Dear Patient:  The management of such an injury will depend on several factors, cheifly, the symptoms associated with the injury, the degree of displacement and any other associated injuries such as injuries to ligaments and tendons . Given the "minimal displacement", location of the injury and time since injury, I am inclined to think that immobilization by an appropriate splint with the addition of anti-inflammatory medication should be adequate treatment. Please note, that there is a increased risk of developing osteoarthritis in this joint since the fracture involves the joint surface. Other potential complications include deformity of the toe and some loss of motion.

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