Use of Nail Traction Splint in the management of Proximal Phalangeal Fractures of the Hand

Vijaykumar, PL (2008) Use of Nail Traction Splint in the management of Proximal Phalangeal Fractures of the Hand. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Fractures involving the tubular bones of the hand are the most common of all skeletal injuries. It accounts for approximately one third of fractures involving the hand. Outer rays of hand especially thumb and little fingers are most commonly involved. Unfortunately these are often neglected or regarded as trivial injuries.Hand fractures can be complicated by deformity from no treatment, stiffness from overtreatment and both from poor treatment. Preventing angular or rotational deformity, articular stiffness, and tendon adhesions challenges the even the most experienced surgeon. As Charnley recognized : The reputation of a surgeon may stand as much in jeopardy from this injury [ phalangeal fracture] as from any fracture of the femur. The incidence of the metacarpal and the phalangeal fractures peaks between 10 and 40 years. Most fractures are functionally stable either before or after the closed reduction and will do well with the protective splintage and early mobilisation. AIM OF STUDY: The main objectives of this clinical study are 1. To discuss the role of traction splint in the management of proximal phalangeal fractures which are not amenable to the other forms of treatment. 2. To evaluate the results of the cases of proximal phalangeal fractures managed by the traction splint. 3. To review the age and sex incidence, mode and the type of injury in cases of proximal phalangeal fractures. 4. To study the commonly involved hand and fingers, type of the fractures, anatomical site of the fracture and the treatment options. 5. To discuss the postoperative management and final outcome. MATERIALS AND METHODS: This study consists of evaluation of all consecutive proximal phalangeal fractures managed in our department from July 2005 to October 2007. This study included 32 patients of proximal phalangeal fractures which are suitable for nail traction system were treated with nail traction splint. The average age of the study group was 27.6 years. The material used for the traction was a long malleable aluminium splint, POP, 3-0 Prolene suture and bandage materials. Methodology:- The factors taken in to account for analysis in this study were 1. Age and Sex of the patient 2. Mode of Injury 3. Type of the wound 4. Anatomical site of the Fracture with presence of intraarticular extension 5. Type of the fracture 6. The involved Hand and fingers RESULTS: The mean time for clinical union was 21 days (14 to 28 days). The mean time for radiological union was 42 days (28 to 56 days). 24 patients had good functional outcome (75%), Six patients had moderate outcome (18.75%) and only two patients (6.25%) had poor outcome. The mean ROM of the involved PIP joints was above 70° in most of the cases. No fixed flexion deformities were observed. All patients returned to their pre injury work status and were satisfied with their overall result. CONCLUSION: Traction splint with long aluminium splint immobilisation, in our study has proved most simple and least invasive procedure not requiring sophisticated bone instruments or manipulation. It is cheap in terms of raw materials, which include: aluminum splint, which can be easily procured cheaply, POP, prolene suture & bandage materials. When compared to other treatment options, it is a technically easier procedure, found to be safe, efficient and effective in the management of proximal phalangeal fractures particularly associated with the comminution and the intraarticular component where other options are too difficult or not possible. Post operative results are good in more than 75% of patients (good plus moderate 93.75%); poor results (6.25%) are rarely seen. Number of complications needing secondary procedures is much less when compared with other methods of management. Good results were observed in most of the patients with very good radiological and functional outcome without significant complications provided good followup could be ensured.In cases with poor follow up the result can turn out to be poor as we observed in two of our cases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Nail Traction Splint ; management ; Proximal Phalangeal Fractures ; Hand.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:33
Last Modified: 17 Sep 2017 05:57

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