Background
Displaced proximal phalangeal fractures of middle and ring fingers can be managed using traction splints.1 This technique involves the application of a forearm cast with an additional padded, malleable metal splint (MS) taped to the volar aspect of the injured finger. Using adhesive strapping, traction is applied in metacarpophalangeal (MCP) joint flexion and in the proximal interphalangeal (PIP) joint extension. The MS is fixed to the cast for up to seven weeks.
Technique
We have devised a Chichester modification to the Southampton technique. Attach some elastic skin tape to each side of the finger, allowing enough tape beyond the finger to apply traction (Fig 1). Select the correctly sized wrist splint (WS) with a metal bar and cut an opening at its distal end (Fig 2). Pass a malleable MS through the WS and bend into position at the distal opening for desired flexion at the MCP joint (Fig 3). Once fitted to the patient, apply traction to the finger through the end of the tape and secure this over the end of the MS (Figures 4 and 5).
Figure 1.
Skin tape applied to each side of the finger
Figure 2.
Opening in the distal end of the wrist splint
Figure 3.
Assembled construct with metal splint
Figure 4.
Traction applied through the end of the tape
Figure 5.
Tape secured to metal splint to maintain traction
Discussion
Wrist splints are designed to finish just prior to the MCP joints to allow for movement of these joints. The addition of a padded metal splint distally for the injured finger facilitates control of the MCP and PIP joints in a position of the surgeon’s choice. Compared to previously described casting techniques, the equipment is readily available (Fig 6), requires no training and is quick and easy to apply. The metal splint can be adjusted if a change of MCP or PIP joint position is required and the construct allows for simpler hand hygiene care as the splint can be washed in situ if soiled and dries relatively fast if wet.
Figure 6.
Equipment required for construction of traction device
Reference
- 1.Fitzgerald JA, Khan MA. The conservative management of fractures of the shafts of the phalanges of the fingers by combined traction-splintage. J Hand Surg Br 1984; : 303–306. [DOI] [PubMed] [Google Scholar]