DYNAMIC DIGITAL TRACTION FOR UNSTABLE COMMINUTED INTRAARTICULAR FRACTURE-DISLOCATIONS OF THE PROXIMAL INTERPHALANGEAL JOINT

Unstable intra-articular fracture-dislocations about the proximal inte rphalangeal joint present a formidable management dilemma. Fourteen pa tients 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 mad e up the majority of cases. Average proximal interphalangeal joint art icular surface involvement was 80%. Immediate motion was instituted af ter traction application. The device was applied in the office with re adily available materials. Al final follow-up examination, active are of motion averaged 89 degrees at the proximal interphalangeal joint an d 95 degrees for patients sustaining isolated injuries. X-ray films re vealed fracture union, joint remodeling, and preservation of joint spa ce. Patient satisfaction was high, with return to previous levels of a ctivity and excellent functional joint restoration. Dynamic digital tr action is recommended for unstable proximal interphalangeal joint frac tures with comminution, including those associated with subluxation or dislocation.