Clin Orthop Surg.  2024 Apr;16(2):322-325. 10.4055/cios23174.

Prolonged Union in Conservative Treatment of Symphalangeal Toe Fractures: Case Series

Affiliations
  • 1Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
  • 2Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
  • 3Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
  • 4Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 5Global Operations and Business Development, Seoul National University Hospital, Seoul, Korea

Abstract

Background
Toe symphalangism is characterized by a fusion of the interphalangeal joint between the middle and distal phalanges. While typical lesser toe fractures heal well with conservative treatment, in our clinical experience, we encountered patients with symphalangeal toe fractures who experienced long-lasting pain and delayed radiographic union. Therefore, this study aimed to report radiographic outcomes following conservative treatment of symphalangeal fractures of the lesser toes.
Methods
We retrospectively reviewed 14 patients with symphalangeal lesser toe fractures who were treated conservatively. We investigated the mechanism of injury and measured the time from the initial injury date to the complete radiographic union. The fracture gap distance was measured on an initial lateral radiograph.
Results
Symphalangeal fractures involved the fourth toe in 4 patients (28.5%) and the fifth toe in 10 patients (71.4%). Regarding the mechanism of injury, 6 patients (42.9%) were injured by stubbing or bumping into the door, 5 patients (35.7%) were injured by tripping, 2 patients (14.3%) were injured by heavy objects falling directly on their toes, and 1 patient (2.3%) complained of pain after wearing pointed shoes for half a day. The mean time to complete union was 9.1 months, and the median period was 5.5 months (range, 0.8–29 months). The initial gap of the fracture was 0.60 mm (range, 0.30–1.04 mm).
Conclusions
The results of our case series may help counsel patients in the outpatient clinic that prolonged healing time may be required for the union of symphalangeal toe fractures.

Keyword

Toes; Fracture healing; Symphalangism of toes
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