The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7-28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74 degrees (range, 0-100 degrees ). The mean total active motion of the injured digit was 196 degrees (range, 40-275 degrees ). Refinements in the regime are suggested as a result of this investigation.

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This prospective study compares subjects following primary repair of flexor tendons in zone 2 using either controlled active motion or a modified Kleinert regime. A matched pairs design was employed, subjects being matched for gender, age and injury characteristics. Twenty-six pairs of subjects with 92 tendon injuries in 52 digits were assessed 12 weeks postoperatively in respect of range of motion and dehiscence. Outcomes were defined using the Strickland criteria. No statistically significant differences in respect of range of motion were demonstrated between the groups. Incidence of rupture, however, was significantly less in the modified Kleinert group (7.7%) than in the controlled active motion group (46%).

Introduction: The results of patients with primary zone II flexor tendon repairs rehabilitated using a traditional forearm-based splint were audited and compared with those who were managed in the Manchester short splint. Method: The short splint was fabricated to permit maximal wrist flexion and up to 45 of wrist extension with a block to 30 of metacarpophalangeal joint extension. A rehabilitation regimen consisting of early combined passive flexion exercises and active motion was employed. In 2011, 62 patients (76 digits) with a mean age of 34 years (range 14-58) were rehabilitated using the forearm-based splint (group A). In 2012, 40 patients (45 digits) with a mean age of 31 years (range 15-71) were rehabilitated using the Manchester short splint (group B). Results: Group B had significantly less flexion contracture at their proximal interphalangeal joints than group A at 6 weeks (median 15 versus 28 ; p ¼ 0.003) and 12 weeks (median 6 versus 18 ; p ¼ 0.024) postoperatively. At the final review, group B had a significantly greater arc of flexion at their distal interphalangeal joints (median 59 versus 30 ; p < 0.001) and a greater proportion of patients with excellent/good Strickland's grades. There were three (3.9%) ruptures in group A and two (4.4%) ruptures in group B (p > 0.999). Conclusion: The use of a shorter splint would appear to enhance the outcomes whilst preserving repair integrity.