Swing traction versus no-traction for complex intra-articular proximal inter-phalangeal fractures

O’Brien, Lisa; Simm, Andrew T; Loh, Ian; Griffiths, Kim Michelle

doi:10.1016/j.jht.2014.07.003

Cited by 8 publications

(9 citation statements)

References 29 publications

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“…With various techniques of treating PIP fracture dislocations, joint stiffness was reported to be one of the (12) .69 Fragment size, mean (SD), % f 46 (20) 47 (20) 40 (20) .44 Fragment displacement, median (IQR), % f,g 45 ( 15) 45 ( 14 most common complications of PIP joint injury. 1,15,19,20,24,25 Stiffness of the joint was the most common indication (40%) for reoperation in our cohort. Seven patients were initially treated with open reduction internal fixation.…”

Section: Discussionmentioning

confidence: 82%

Reoperation After Operative Fixation of Proximal Interphalangeal Joint Fractures

Oflazoglu

Wilkens

Rakhorst

et al. 2019

Hand (New York, N,Y.)

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Background: The purpose of this study was to determine the reoperation rate and what factors are associated with reoperation of proximal interphalangeal (PIP) joint fractures. Methods: We identified 161 surgically treated PIP joint fractures between 2004 and 2015 at 2 academic medical systems. Demographic, injury, radiographic, and treatment data that might be associated with reoperation were collected. Bivariate analysis was performed. Factors identified during bivariate analysis with a P < .10 were entered into a multivariable logistic regression analysis. Results: Of the 161 fingers, 25 underwent revision surgery. Open fracture was independently associated with revision surgery. The most common indication for reoperation was joint stiffness (35%). In a subanalysis of 111 closed fractures, no factors were associated with revision surgery. Conclusions: Soft tissue injury is a major factor in reoperation after PIP joint fracture dislocation. Specific attention should be paid to persistent subluxation because this may predispose to early arthrosis.

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Section: Discussionmentioning

confidence: 82%

Reoperation After Operative Fixation of Proximal Interphalangeal Joint Fractures

Oflazoglu

Wilkens

Rakhorst

et al. 2019

Hand (New York, N,Y.)

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“…A less invasive method than ORIF for the management of PIP joint fractures is the use of traction. A comparative study by O’Brien et al (2014) examined outcomes of PIP joint fractures of 30-60 per cent articular surface involvement. One group received a dynamic traction orthosis using skeletal traction via K-wire ( n = 17), the other received operative or conservative treatment without traction ( n = 14).…”

Section: Introductionmentioning

confidence: 99%

“…The study reported the mean combined ROM of the PIP and DIP joint was superior in the swing traction group compared to the no-traction group (P = 0.008). Patient ratings of pain level, function and satisfaction were not significantly different between groups ( p- values 0.52, 0.883 and 0.52, respectively) (O’Brien et al , 2014). A 2016 scoping review of the use of traction constructs in the management of intra-articular fractures did not identify the best treatment method because of the paucity of randomised trials and the variation in reporting of fracture classification and outcome measures (Packham et al , 2016).…”

Section: Introductionmentioning

confidence: 99%

“…PIP joint fracture patients are frequently referred for hand therapy intervention. Early motion is recognised as important in the non-operative and post-operative management of closed intra-articular fractures of the PIP joint (O’Brien et al , 2014; Kang and Stern, 2002; Stern et al , 1991; Hirth et al , 2013; Ikeda et al , 2011; MacFarlane et al , 2015; Watanabe et al , 2015). Early motion can be facilitated by timely referral to occupational therapy and physiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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An investigation of the acute management of closed intra-articular fractures of the proximal interphalangeal joint in Ireland

Harmon¹,

Spirtos

2020

IJOT

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Purpose Many treatment methods for intra-articular fractures of the proximal interphalangeal (PIP) joint are described in the literature without a consensus on the most effective approach. The purpose of this study was to investigate the methods of treatment of PIP joint fractures being used by trauma surgeons in the Republic of Ireland currently and the timing of referral to therapy. Design/methodology/approach A cross-sectional descriptive study methodology was used to survey trauma surgeons, occupational therapists and physiotherapists in Ireland. An online platform was used. A total of 21 surveys were returned by surgeons and 37 by therapists. Descriptive statistical analysis was used to present the results. Findings Buddy strapping was reported as the primary treatment method for stable PIP joint fractures. All levels of fracture severity were reported to be treated using traction constructs, which include static and dynamic fixation and orthoses. Unstable fractures were managed using open reduction with internal fixation by 50 per cent of surgeons. Early timing of referral to therapy is reported by more surgeons than therapists. The majority of therapists indicated that they did not have the resources to see patients at the optimal time. Originality/value To the authors’ knowledge, this study provides the first description of the management of PIP joint fractures across the Irish health service. The findings of this study suggest that additional therapy resources are required within the health service executive to facilitate the desired early referral to therapy and to enable service development for this category of hand fractures.

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“…Due to poor outcomes of conservative treatment and technical difficulty of open treatment, dynamic external fixation has gained a leading role in fracture management. In a recent review, patients treated with traction had superior ROM in the involved digit compared to treatment options with no traction (27).…”

Section: Introductionmentioning

confidence: 99%

A comparative cadaveric biomechanical analysis of the differences between dynamic external traction devices for PIP joint fracture dislocation.

Thibaudeau

Diaz-Abele

Luc

2018

MJM

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Purpose: No study in the literature compares different external distractors for PIPJ injury. We compared a device described by Suzuki et al and another by Hynes & Giddins in non-injured cadaveric fingers. Main outcome measures were articular space and PIPJ flexion resistance.Methods: Thirty-two Thiel embalmed fingers were used. The elastics based model was performed with 3 and 5 elastics per side (3E and 5E); the 2-pin model used no elastics (2P). Articular distraction of each device was measured using x-ray imaging. The force required to flex the PIP joint to 45˚ and 90˚ in each group was measured with a dynamometer.Main findings: The articular distraction was statistically significant for all groups. The difference in articular distraction was significant in the AP view between groups 3E and 2P, and 5E and 2P. Flexion forces were only significant between group 5E and 2P at 90˚ flexion, but resistance was notably higher in group 2P than in groups 3E and 5E. Group 2P was more difficult to engage and often disengaged in flexion compared to groups 3E and 5E.Conclusion: All devices achieved significant articular distraction (>99% in AP) but optimal distraction has not been clinically determined and may depend on each unique fracture, hence a variable distraction device may be optimal. The 3E and 5E models can be adjusted for distraction by adding the sufficient elastics to reduce individual fractures. The increased resistance to PIP flexion found in the 2P model may limit post-op mobilization, but clinical correlation is needed.

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Swing traction versus no-traction for complex intra-articular proximal inter-phalangeal fractures

Cited by 8 publications

References 29 publications

Reoperation After Operative Fixation of Proximal Interphalangeal Joint Fractures

Reoperation After Operative Fixation of Proximal Interphalangeal Joint Fractures

An investigation of the acute management of closed intra-articular fractures of the proximal interphalangeal joint in Ireland

A comparative cadaveric biomechanical analysis of the differences between dynamic external traction devices for PIP joint fracture dislocation.

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