Early Active Vector Adjustable Skin Traction (EAVAST) for Phalangeal Fractures

Abstract

Background: Traction for phalangeal fractures utilizes the principle of “ligamentotaxis.” In Australia, a number of hand therapists and surgeons have contributed to the design of a skin traction method utilizing rigid sports tape, elastic, and hand-based thermoplastic splint. Aims: The study aims to determine the efficacy and outcomes of skin traction in the treatment of phalangeal fractures in comparison with surgical management. It also aims to define the vectors, force, types of phalangeal fracture, and degree of displacement that skin traction can improve. Method: A retrospective cohort trial is currently underway reviewing outcomes of 103 skin traction cases involving phalangeal and metacarpal fractures performed at the Nepean Hospital in New South Wales over a 3-year period and comparing these to surgical cases. Outcome measures being utilized include total active movement (TAM), grip strength, pain levels, and patient rated wrist and hand evaluation (PRWHE) scores. Radiological analysis is also being undertaken with the intention of developing an algorithm to match the type of fracture with recommended treatment method. We are currently in the process of collecting surgical group data and expect to be able to present this by the time of conference meeting. Results: Preliminary results according to Belsky’s criteria indicate an average of 227.50 total active motion for 54 phalangeal finger fractures treated with the technique. The results were excellent for 37 cases, good for 14 cases, and poor for 3 cases. Grip strength averaged 32.3 kg for the affected limb (99.3% of the non-affected limb). Gingrass criteria for thumb phalangeal outcomes in 6 cases showed average 82.2° TAM for five (5) cases. Excellent outcomes were achieved in 3 cases, and good outcomes were achieved in 2 cases. Pinch strength averaged 4.25 kg and was 79.7% of the non-affected thumb. Conclusion: Skin traction may provide a cost-effective and clinically effective tool for the management of phalangeal fractures.

Alternative Noninvasive Treatment of Unstable Extra-articular Proximal and Middle Phalangeal Fractures: A Static Linear Traction Orthosis Design

“…Static linear traction is an effective approach to managing these fractures through tensioning soft tissues, maintaining their optimal length and neutralizing deforming forces. 1,[9][10][11][12][13] While different techniques have been described using various materials, 9-13 these approaches limit the ability to perform skin hygiene, make calculated adjustments, or are high profile. The purpose of this paper is to describe the alternative orthosis design which has successfully been implemented at our center.…”

“…While dynamic traction has been well established in the management of intra-articular middle phalangeal fractures,7,8 the technique remains not widely applied with unstable extra-articular phalangeal fractures. Static linear traction is an effective approach to managing these fractures through tensioning soft tissues, maintaining their optimal length and neutralizing deforming forces 1,9–13…”

“…While different techniques have been described using various materials,9–13 these approaches limit the ability to perform skin hygiene, make calculated adjustments, or are high profile. The purpose of this paper is to describe the alternative orthosis design which has successfully been implemented at our center.…”