Do Intra-articular PIP Fractures Do Better With Swing Traction or No-Traction Protocols? A Cohort Study

Abstract

Objective/Hypothesis: The objective of this study was to compare swing traction versus no-traction management of complex fractures of proximal interphalangeal (PIP) finger joints. We hypothesized that there is no long-term (ie, >12 month) difference between swing traction and no traction (with or without surgical fixation) in terms of motion, pain, function, patient satisfaction, or treatment cost. Materials and Methods: This cohort study recruited adults with a history of complex PIP fractures affecting ≥ 30% of articular surface injury identified from database searches at 3 public hospitals and a private clinic. The x-rays taken at the time of injury were graded by 2 blinded assessors, and participants attended a clinic for measurement of range of motion (ROM) and self-reported function, pain, and satisfaction. Participant data were then grouped by treatment provided. One group (n = 17) was treated with swing traction and the other group (n = 14) had no traction. The primary outcome was combined motion of the PIP and distal interphalangeal (DIP) joints, expressed as both total active motion and Strickland score. Secondary outcomes were physical function and symptoms as measured by the Disabilities of Arm, Shoulder and Hand (DASH), patient satisfaction, pain, complication rates, and cost of treatment, based on mean resource consumption per group. Results: Patients treated with swing traction had greater finger motion than those in the no-traction group, which was statistically and clinically significant. There were no differences in patient ratings of function, pain, or satisfaction. Complications, such as swan-neck deformity, cold sensitivity, malunion, infection, or adhesions occurred in over half of both groups of participants. During the treatment phase, the swing traction group attended hand therapy an average of 13.3 times and the no-traction group attended 11.7 times. Average costs for swing traction were less than that for surgical fixation with no traction. Conclusions: Patients treated with the swing traction protocol had greater ROM in the finger; however, this did not translate to improved patient ratings of function, pain, or satisfaction. A basic cost comparison indicated that swing traction may be less expensive than other forms of surgical repair.