Methods: A retrospective chart review of patients treated for distal phalanx fractures between 1998 and 2001 was conducted. Only patients with isolated distal phalanx injuries with greater than 2 months’ follow-up were included. Patients were grouped into those with open fractures and those with closed fractures. Open fractures were either treated acutely with operative irrigation/debridement and fracture fixation within 6 hours of the injury or in a delayed fashion. Delayed treatment entailed local wound care in the emergency department, oral antibiotics, and clinic follow-up within 24 hours. Operative irrigation/debridement and fracture fixation were performed within 24 hours of this clinic visit. Closed fractures were either splinted or treated with closed reduction and percutaneous pinning. Postoperatively, patients were evaluated weekly with clinical examination and radiographs until there was evidence of clinical or radiographic union. Kirschner wires were generally removed at 3-4 weeks. Occupational therapy was then begun. The incidence of infection, radiographic nonunion, and secondary procedures was determined for each group. Statistical analysis was conducted using the chi-squared test with continuity correction.

Results: Ninety-one patients with distal phalanx fractures were identified. Fifty-five patients satisfied the inclusion criteria: 14 with closed fractures and 41 with open fractures. Twenty-seven open fractures were treated acutely and 14 delayed. The incidence of infection was 0/14, 0/27, and 1/14, for closed fractures, acute treatment of open fractures, and delayed treatment of open fractures, respectively (0.30 > p > 0.20). The incidence of nonunion was 1/14, 8/27, and 5/14, for closed fractures, acute treatment of open fractures, and delayed treatment of open fractures, respectively (0.20 > p > 0.10). The number of secondary procedures required was 0/14, 1/27, and 1/14, for closed fractures, acute treatment of open fractures, and delayed treatment of open fractures, respectively (0.50 > p > 0.30).

Discussion: To our knowledge, no study has previously determined whether or not open distal phalanx fractures must be treated with emergent operative irrigation and debridement. We found no statistically significant difference in the rates of infection and nonunion whether open distal phalanx fractures were treated acutely or in a delayed fashion. Moreover, infection and nonunion were statistically no more common than in closed fractures. Typically, radiographic nonunions were clinically asymptomatic. Delayed treatment of open distal phalanx fractures does not increase the risk of infection or nonunion.