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Three Part Question

In [adults with toe phalanx fractures] is [intervention and follow up better than no intervention] at [reducing pain, reducing time to return to normal activity, reducing requirement for interventional surgery or improving long term pain or gait issues.]

Clinical Scenario

A 35 year old builder presents to the emergency department having dropped a paving slab on his toes. He has swollen painful great toe on the right foot. An x-ray shows he has sustained a closed fracture of the distal phalanx of the great toe. No other injuries have been sustained.

Search Strategy

Medline 1947 to August 2012 using the OVID interface

[{(toe.mp or phalanx$.mp) and (exp. Foot fracture)}.

Search Outcome

Forty papers were identified one of which answered the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Vliet-Koppert et al, 2011 The Netherlands	All patients with toe fractures presenting to the emergency department between 2006 and 2008. 339 patients with toe fractures, 264 who were between ages 16-75 were sent postal surveys	Retrospective cohort with survey	Survey response	141/264	Retrospective cohort. Poor response rate to survey. Not all participants answered the midfoot score
			Median follow up time	27 months
			Treatment	66/141 splinted with adjacent toe
			American Orthopaedic Foot and Ankle Society midfoot score	120/141 could run, 106/141 could stand on toes, 116/141 could walk barefoot

Comment(s)

There is little published literature comparing the management of toe phalanx fractures.

Clinical Bottom Line

There is no evidence to determine whether intervention of any type improves outcome in toe phalanx fractures. Local advice should be followed.

References

1. Vliet-Koppert ST, van Cakir H, Lieshout EMM, et al Demographics and functional Outcome of Toe Fractures. J Foot Ankle Surg 2011;50:307 10