Hand-based swing traction splinting for intra-articular proximal interphalangeal joint fractures

Abstract

Introduction Acute intra-articular fractures of the proximal interphalangeal joint have always presented as a difficult injury to manage for the treating surgeon and therapist. Traction management enabling ligamentotaxis and motion is a popular method to manage these injuries. This case series presents the design and results of hand-based swing traction splinting which is less cumbersome for patients than other forms of traction splinting.

Methods Five patients presenting with intra-articular proximal interphalangeal joint fractures underwent surgery whereby a transverse K-wire was inserted across the middle phalanx. The treating Occupational Therapist fabricated a hand-based swing traction splint to provide a distraction force from the K-wire to the splint. Range of motion and patient satisfaction were the primary outcome measures.

Results All five patients reported satisfaction with their hand function following therapy involving swing traction splinting. Furthermore, range of motion was comparable to other forms of traction management reported in the literature with an 88° mean arc of motion at the proximal interphalangeal joint.

Conclusion This case series demonstrates that hand-based swing traction splinting is a viable treatment option for the management of intra-articular proximal interphalangeal joint fractures. With similar outcomes to other forms of distraction that enable early movement, such as the pins and rubber traction system, this design is an alternative. The less cumbersome splint design is the main advantage over other splinting methods that apply distraction whilst also enabling early motion.