The efficacy of arcuate dynamic traction splintage in the treatment of intra-articular fractures of the proximal interphalangeal joints of the hand: A retrospective descriptive review
Intra-articular fractures involving the proximal interphalangeal joint of the hand present both the surgeon and hand therapist with one of the most challenging problems in which to achieve an acceptable functional outcome. The main aim of this study was to document the outcomes of patients treated with dynamic traction splintage treatment. Secondly, the study aimed to compare the results of patients treated with dynamic traction splintage with those of patients treated with similar or different treatment regimes as documented in the literature. Results from 21 patients treated with Dynamic Traction Splinting are presented. Average follow-up was 16.5 months (5 weeks – 36 months) with a mean TAROM outcome of 78o as compared to 95o on the uninjured side. Mean patient age was 36 years (16 – 74 years). Imaging documented an average articular surface involvement of 53%. The average time between injury and splintage was 3.1 days in 19 patients and 14.5 days in 2 patients - these later two were defined as chronic injuries. The majority of patients injured their finger at sport, the most common of these being cricket. The splint was worn for an average of 4 weeks (3 –7 weeks). All patients were fully employed at the time of injury and returned to work within 3 months. Pin site infection was the main early complication, whereas mild coronal angular deformity was the only late complication noted. Patient feedback related to the cumbersome nature of the splint in two thirds of the group, with intermittent pain, stiffness and cold intolerance being equally shared by a third of the group. The majority of patients stated that they were satisfied with their final functional outcome at the time of follow-up.