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Avoiding Pitfalls of the Pins and Rubbers Traction Technique for Fractures of the Proximal Interphalangeal Joint

Agarwal, Anil K. MS, MCh (Plast), FRCS (Glasgow); Karri, Vasu BSc (Hons), MRCS; Pickford, Mark A. MS, FRCS (Plast)

doi: 10.1097/01.sap.0000245125.59100.52
Original Article
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Treatment of comminuted intra-articular fractures of the digits with the Pins and Rubbers Traction System (PRTS) has been reported in many small series to give good results. Our experience in more than 40 cases with this technique, however, has not always been favorable. We analyzed outcomes and complications of PRTS treatment in 25 patients with proximal interphalangeal joint fractures reviewed at a mean 13 months (range, 6–52 months) after surgery. Mean arc of motion at this joint was 67.2° (range, 35–110°) and at the distal interphalangeal joint 40.7° (range, 0–90°). The latter was immobile in 3 (12%) and 7 patients (28%) had superficial pin track infections. Loss of extension at both joints was a major factor in poor outcomes. Based on this experience, we suggest ways of avoiding common pitfalls of PRTS treatment. Concurrent internal fixation impacts significantly on interphalangeal joint stiffness.

Twenty-five complex intra-articular finger fractures were treated with the pins-and-rubbers technique, resulting in mean PIP joint ROM of 67.2 degrees at 13 months. Based on this experience, the authors recommend centering the traction pin perpendicular to the long axis of the ray with the vertical limbs adequately spaced from the digit and maintenance of true “glide” during PIP flexion.

From the Department of Plastic Surgery, The Queen Victoria Hospital, West Sussex, U.K.

Received May 29, 2006, and accepted for publication, after revision, August 23, 2006.

Reprints: Anil K. Agarwal, MS, MCh (Plast), FRCS (Glasgow), Department of Plastic Surgery, The Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, U.K. E-mail: plastic72@doctors.org.uk.

© 2007 Lippincott Williams & Wilkins, Inc.