Article

Traction orthoses are thought to optimize recovery from
intra-articular finger fractures by restoring joint space and allowing early
motion. Evidence to date has, however, consisted only of case series. PURPOSE: To compare swing traction versus no-traction management of complex
fractures of proximal inter-phalangeal (PIP) finger joints. We hypothesized that
there is no long-term (i.e. >12 month) difference between swing traction and
no-traction (with or without surgical fixation) in terms of motion, pain,
function, patient satisfaction, or treatment cost.
METHODS: Adults with a history
of complex PIP fractures affecting >/=30% of articular surface injury were
identified from database searches at three public hospitals and a private clinic
and invited to participate. X-rays taken at the time of injury were graded by two
blinded assessors, and participants attended a clinic for measurement of range of
motion (ROM) and self-reported function, pain, and satisfaction at least one year
post injury. Participant data were then were grouped by treatment provided. One
group (N = 17) was treated with swing traction and the other group (N = 14) had
no-traction. The primary outcome was combined motion of the PIP and distal
inter-phalangeal (DIP) joints, expressed as both total active motion and
Strickland score. Secondary outcomes were physical function and symptoms as
measured by the Disabilities of Arm, Shoulder and Hand (DASH), patient
satisfaction, pain, complication rates, and cost of treatment, based on mean
resource consumption per group. RESULTS: Patients treated with swing traction had
greater finger motion than those in the no-traction group, which was
statistically and clinically significant. There were no differences in patient
ratings of function, pain or satisfaction. Complications, such as swan-neck
deformity, cold sensitivity, malunion, infection, or adhesions occurred in over
half of both groups of participants. During the treatment phase, the swing
traction group attended hand therapy an average of 13.3 times, and the
no-traction group attended 11.7 times. Average costs for swing traction were less
than for surgical fixation with no-traction. DISCUSSION: The significantly
different range of motion found in our study did not translate to better DASH
scores. The DASH is designed to measure global upper limb physical functioning
and symptoms, but lacks sensitivity in populations with finger injuries.
CONCLUSIONS: Patients treated with the swing traction protocol had greater range
of motion in the finger, however this did not translate to improved patient
ratings of function, pain or satisfaction. A basic cost comparison indicated that
swing traction may be less expensive than other forms of surgical repair. LEVEL OF EVIDENCE: 3.
CI - Crown Copyright (c) 2014. Published by Elsevier Inc.
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Langue : ANGLAIS