An exciting subject to start with!
A major textbook of fractures & dislocations covers toe injuries in 3 pages, of which 2 are text.
The only recent paper that covers outcome of toe fractures in any detail using outcome scoring:
‘Demographics and Functional Outcome of Toe Fractures.’
Sabine T. Van Vliet-Koppert MD, Hamit Cakir MD, Esther M.M. Van Lieshout PhD, Mark R. De Vries MD, PhD, Maarten Van Der Elst MD, PhD and Tim Schepers MD, PhD
Journal of Foot and Ankle Surgery, The, 2011-05-01, Volume 50, Issue 3, Pages 307-310. Copyright © 2011 American College of Foot and Ankle Surgeons
Open reading mode (I assume this means that the abstract can be reproduced as it is not behind a paywall).
Abstract
Toe fractures are common; however, there are few data on demographics and functional outcome. We studied outcomes in 339 consecutive patients with toe fractures treated between January 2006 and September 2008. Two hundred and sixty-four patients, aged 16 to 75, were mailed an outcome questionnaire, and overall subjective satisfaction with the outcome of treatment was measured using a visual analog scale (VAS). Most frequently affected were the first (38%) and fifth (30%) toes, and most (75.6%) of the fractures were caused by stubbing or crush injury. More than 95% of the fractures were displaced less than 2 mm, and all of the fractures were treated conservatively. The questionnaire was returned by 141 (53%) patients with a median follow-up of 27 months. Respondents were female in 57.4% of cases and had a median age of 45 years. The median AOFAS score was 100 (P 25 , P 75 = 93,100) points; the median VAS was 10 (P 25 , P 75 = 8, 10) points. Univariate regression analysis revealed no statistically significant associations between outcome and the particular toe or phalanx involved, number of fractured toes, fracture type and location, articular involvement, gender, age, body mass index, smoking habits, and the presence of diabetes mellitus. Satisfaction VAS was dependent on age ( P = .047) and gender ( P = .049) in the multivariate analysis. The AOFAS midfoot score was not influenced by any of the covariates. This is the first epidemiological investigation using 2 outcome-scoring systems to determine function and satisfaction following treatment of toe fractures.
Caveats about this paper:
Retrospective
Poor response rate (53%)
However, I think it would be a mistake to assume that toe fractures do well regardless.
It would also be a mistake to think that there is never an indication for surgery to a toe fracture; there may be rare circumstances where a poor outcome from conservative management can be anticipated.
For example, a widely-displaced articular fracture of the hallux may merit stabilization; an irreducible dislocation of the inter-phalangeal joint of the hallux requires reduction.
In a mangled foot, K-wire stabilization of metacarpals and toes may help with soft tissue care.
Beware open fractures, especially those masquerading as nailbed injuries. They need treating as any other open fracture, otherwise bone/joint sepsis can spoil the outcome.
A toe injury can (rarely) trigger chronic regional pain syndrome, which certainly can be disabling unless successfully treated.
Severe crush injuries can result in ischemia and toe separation/amputation. If the toe survives, cold sensitivity can be a problem (although not as much of a problem as it is in the hand).