Dynamic digital traction for unstable comminuted intra-articular fracture-dislocations of the proximal...

Unstable intra-articular fracture-dislocations about the proximal interphalangeal joint present a formidable management dilemma. Fourteen patients with comminuted injuries of the proximal interphalangeal joint were treated with dynamic digital traction and followed for an average of 24 months. Dorsal fracture-dislocation and pilon-type injuries made up the majority of cases. Average proximal interphalangeal joint articular surface involvement was 80%. Immediate motion was instituted after traction application. The device was applied in the office with readily available materials. At final follow-up examination, active arc of motion averaged 89 degrees at the proximal interphalangeal joint and 95 degrees for patients sustaining isolated injuries. X-ray films revealed fracture union, joint remodeling, and preservation of joint space. Patient satisfaction was high, with return to previous levels of activity and excellent functional joint restoration. Dynamic digital traction is recommended for unstable proximal interphalangeal joint fractures with comminution, including those associated with subluxation or dislocation.