Treatment of fractures of the proximal phalanx of long fingers with an isometric traction splint.

Treatment of fractures of the proximal phalanx of the long fingers remains difficult and challenging ; several options have been used. We report our experience with an isometric traction splint, modified from the Southampton design. A cohort of 32 patients with displaced fractures of a proximal phalanx was treated and assessed retrospectively after a short term (9 weeks after splint application). Traction splint was applied to realign the fracture and to control rotation. This construct was used for approximatively 5 weeks (mean: 36 days; range: 21-44 days), considering the usual progression of fracture healing in closed phalangeal fractures and patient tolerance to the splint. Three weeks after splint removal, almost full range of motion was regained in the metacarpophalangeal and interphalangeal joints in all patients, except in 3 cases. Two of these three patients had a displaced fracture of the proximal phalanx as a result of a compression trauma. The combination of the trauma type with static traction splint led to a tenodesis effect with a severe active flexion deficit in the metacarpophalangeal and interphalangeal joints. Our results suggest that isometric traction splint is a valid treatment option for displaced fractures of the proximal phalanx, however compression type fractures should be excluded.