[Dynamic external traction system for management of distal displaced fractures of the head of the proximal phalanx].
BACKGROUND
Phalangeal fractures are generally underestimated injuries, but result in pain, stiffness, instability, degenerative arthritis and loss of finger function. Treatment varies from open reduction with internal fixation giving perfect anatomical reduction but a risk of side effects, to orthopaedic treatment with variable results. Unstable fractures must be fixed rigidly to minimize joint immobilization. It is this concept of solid fixation and early mobilization, which directed us in the choice of dynamic external distraction in the management of these fractures.


METHODS
The authors present a prospective study of twelve patients treated for unstable fractures of the proximal interphalangeal joint by closed reduction and dynamic external distractor, we describe this simple device created with pins and rubber bands and examine the functional clinical results.


RESULTS
The average follow-up period was 7.5 months. We only noted one pin-track infection. Three patients complained of pain at postoperative follow up. In this series, the total active motion varied from 70 degrees to 120 degrees (average 94.16 degrees), the mean lack of extension was 5.6 degrees (from 0 to 15 degrees). Ten patients had good mobility and were satisfied.


CONCLUSIONS
Different traction devices for the management of displaced intraarticular phalangeal fractures have been reported. Most of them are complex to construct and expensive. The traction system is simple to assemble, economical and it allows early active motion of the affected digits. We consider that it is an effective mode of treatment for the management of complex intraarticular phalangeal fractures.
El Khatib
K
K
Service de chirurgie maxillofaciale et chirurgie plastique, hôpital Général, CHU de Dijon, 3, rue du Faubourg Raines, 21033 Dijon cedex, France. kelkhatib@gmail.com
Kadlub
N
N
Trost
O
O
Danino
A-M
AM
Malka
G
G
D000293:Adolescent; D000328:Adult; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D013997:Time Factors; D014143:Traction / Q000295:instrumentation*; D016896:Treatment Outcome