A Comparison of Functional Outcomes in Open Fractures of Phalanges, Early Versus Delayed Treatment, and Considerations on Tulipan’s Classification

Background: Open phalangeal fractures raise timing questions that may not mirror long-bone protocols. We aimed to test whether time-to-surgery is associated with infection, time to union, and return to work. Methods: A single-centre retrospective cohort study was conducted between October 2023 and January 2025. Adults with open phalangeal fractures were grouped by time-to-surgery: ≤24 h (A), 24–72 h (B), and ≥72 h (C). Primary outcome was infection while secondary outcomes were time to radiographic union and time to return to work. Results: Ninetypatients were finally included. Baseline demographics and injury characteristics did not differ significantly among groups (all p >0.05). Infection occurred in 10/90 patients (11%); rates were similar across the three windows—10%, 10%, and 12%—with no association between timing and infection (χ2 = 0.09; p =0.96). Mean time to union was 48.4 ± 16.2, 56.0 ± 2.9, and 47.8 ± 14.4 days for the ≤24 h, 24–72 h, and ≥72 h groups, respectively, without significant between-group differences (p = 0.61). Return to work occurred at 92.0 ± 25.5, 70.0 ± 17.3, and 74.0 ± 46.0 days, again with no significant difference by timing (p = 0.53). Overall, no clinically meaningful trend favoured earlier surgery within the studied windows. Conclusions: In this heterogeneous yet clinically representative cohort of open phalangeal fractures, surgical timing up to and beyond 72 h was not associated with infection, time to union, or time to return to work. These findings support individualized decision-making, while larger prospective studies are needed to refine timing thresholds.