Static Traction and Early Mobilization Protocol for Intra-articular Fractures of Proximal Interphalangeal Joint: Technique and Outcome

Abstract

Aim and background: Intra-articular fractures of the proximal interphalangeal (PIP) joint are a difficult entity to treat, commonly leading to stiff and painful fingers. There are multiple techniques described for treatment. We utilize a simple technique consisting of a static traction assembly and early mobilization of the finger to treat this pathology. In this study, we present results obtained with this modality. Materials and methods: We utilize a malleable aluminum splint for traction against the injured finger. No. 1 polypropylene suture through nail plate of injured finger applies traction to hold joint in reduced position for 2 weeks. At 2 weeks, active-assisted mobilization of the injured finger is begun. Patients were evaluated for the range of motion achieved, radiograph picture, presence of pain, and ability to return to work. Results: There were 11 cases of intra-articular fractures of the middle phalanx base. The median period of follow-up was 15 months (range 7.5-31 months). The average active flexion possible at the injured joint was 87.7°(range 55-110°). Two patients reported mild pain on terminal flexion without functional limitations. In unstable injuries, suboptimal alignment of fracture was common [9 out of 11]. Despite suboptimal radiographs, patients had a functional, painless range of motion. All patients went back to previous work. Conclusion: Static traction technique with early mobilization protocol is a safe, relatively simple, and effective technique in the management of intra-articular fractures of the PIP joint. Early mobilization of joint facilitates remodeling of the articular base of the middle phalanx with the recovery of painless motion at the PIP joint despite radiological abnormalities.

Keywords

• fracture-dislocation
• mobilization protocol
• proximal interphalangeal joint
• static traction