Clin Orthop Surg.  2012 Jun;4(2):156-162. 10.4055/cios.2012.4.2.156.

Management of Proximal Phalangeal Fractures of the Hand Using Finger Nail Traction and a Digital Splint: A Prospective Study of 43 Cases

• Jehan S
• Chandraprakasam T
• Thambiraj

• KMID: 1383878
• DOI: http://doi.org/10.4055/cios.2012.4.2.156

Abstract

BACKGROUND
Proximal phalangeal fractures are common fractures of the hand. The fractures are difficult to treat because of vicinity of two important joints and crossing long tendons. The purpose of this study was to evaluate the efficacy of nail traction technique in the management of proximal phalangeal fractures of the hand.
METHODS
Patients (n=43) with proximal phalangeal fractures were treated by nail traction and evaluated prospectively. We assessed all the patients at the time of presentation and then followed a standard protocol for recruiting patients. After application of nail traction, the patients were initially assessed at 12th day. The outcome measures included post reduction radiographic evaluation and total active motion (TAM) in finger at the final follow-up appointment. All the patients were followed for one year.
RESULTS
The post-reduction X-ray evaluation showed good reduction in 33 cases, fair reduction in 8 and poor reduction in 2 cases. At final assessment, 35 patients had good TAM score, six had fair and two had poor TAM score. Complications were noted in two patients and these included pressure necrosis in palm and stiffness in proximal interphalangeal joint.
CONCLUSIONS
The results of this prospective study show that with careful selection of patients, nail traction seems to be simple, safe and effective technique for managing proximal phalangeal fractures.

Keyword

Proximal phalangeal fractures; Conservative treatment; Nail traction; Hand fractures; Digital splint

MeSH Terms

Adolescent
Adult
Aged
Female
Finger Phalanges/*injuries/radiography/*surgery
Fractures, Bone/radiography/*surgery
Humans
Male
Middle Aged
Nails/*surgery
Prospective Studies
Range of Motion, Articular/physiology
Splints
Traction/*methods
Treatment Outcome

Figure

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  Fig. 1 Study protocol and criteria for recruiting the cases for study. The bold arrows and shaded boxes show the criteria for including patients for the study.

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  Fig. 2 Steps in application of nail traction. After passing the suture through the nail the aluminium splint is bent and incorporated in the plaster of Paris (POP) cast (A). Then the free ends of sutures are tied over the aluminium splint (B). The final bandage is applied over the POP slab to secure the position of slab with traction splint (C).

• 

  Fig. 3 Pre-reduction image of proximal phalangeal fracture showing dorsal angulation.

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  Fig. 4 Immediate post-reduction image of the fracture shown in Fig. 3. After application of finger nail traction the position was accepted.

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