Dowd Dynamic Skin Traction for Phalangeal Fractures

Background - Traction for phalangeal fractures utilises the principle of ligamentotaxis. In Australia a number of hand therapists and surgeons have contributed to the design of a skin traction method utilising rigid sports tape, elastic and a hand based thermoplastic splint.

Aims - To determine the efficacy and outcomes of skin traction in the treatment of phalangeal fractures in comparison to surgical management. The study also aims to define the vectors and severity grades of fracture displacement that skin traction can improve.
Method - A retrospective cohort trial is current underway reviewing 103 skin traction cases involving phalangeal and metacarpal fractures performed at the Nepean Hospital in NSW and comparing these with surgical cases. Outcome measures include TAM, Grip Strength, and PRWHE scores. Radiological analysis is also being undertaken.
Results – Preliminary results using Belsky's criteria indicate an average of 227.5 degrees total active motion for 54 phalangeal cases treated with skin traction. Excellent results were found for 37 cases, Good results in 14 and Poor in 3 cases. Grip strength averaged 32.3kg for the affected limb. Gringrass criteria will be used to assess thumb phalangeal cases.
Conclusion – Skin traction may provide a cost and clinically effective tool for the management of phalangeal fractures. Further research is being considered in relation to determining optimal forces required to realign fractures; and methods to maintain realigning forces.