Total active range of movement after treatment using a traction orthotic for extra-articular phalangeal fractures: A case series

BACKGROUND: The use of traction orthoses for complex finger fractures is not a common intervention though some research purports its efficacy as an alternative treatment approach to surgery in some scenarios.

PURPOSE: This study examined total active of range of movement (TAROM) outcomes achieved by patients on discharge from hand therapy after being treated using a traction orthotic following an extra-articular displaced proximal or middle phalangeal fracture.

STUDY DESIGN: A retrospective, consecutive longitudinal case series.

METHODS: Data was collected on the time from injury to traction, duration of traction, injury location (hand, digit, phalanx), fracture classification, age, sex, hand dominance, number of therapy sessions (mobilization phase of rehabilitation), duration from injury to discharge from hand therapy and TAROM at discharge. TAROM outcomes are categorized using the criteria recommended by the American Society of Surgery of the Hand. Categorical variables are summarized using frequency and percentages. Continuous data is summarized as mean and standard deviation or median and interquartile range. Any potential correlations between TAROM and time from injury to discharge were analyzed using Pearson's correlation (two-tailed).

RESULTS: Twenty-three patients were referred for traction (14 male: nine female). Three people went on to have surgery and two patients were lost to follow-up. Mean TAROM was 230.9º (SD 22.6º) indicating a good outcome using the American Society of Surgery of the Hand criteria. Mean time from injury to discharge was 65.6 (SD 30.4) days. There was no correlation observed between time from injury to discharge and TAROM on discharge (r = -0.18, p = 0.48).

CONCLUSIONS: Good and excellent TAROM was achieved following treatment using traction orthoses for extra-articular phalangeal fractures though further studies are necessary. Larger sample sizes will allow for more granular analysis of different fracture classifications.