gms | German Medical Science

Clinical issue/s: "Ligamentotaxis" refers to the process of distal traction to realign joint surfaces and reduce articular fragments after complex fractures. The use of ligamentotaxis in the management of complex finger fractures has reported benefits in fracture alignment and reduction, range of movement (ROM), pain, grip and function. Traction has been applied via nail anchors, skin traction and external fixation.

Phalangeal fractures respond unfavourably to immobilisation. The benefits of early mobilisation are that it aids healing, cartilage regeneration and it helps prevent adhesions. One disadvantage of dynamic traction orthoses is that they typically need to be "high-profile" to sustain traction through the arc of movement. Most dynamic traction orthoses incorporate external fixation, though two methods have reported good outcomes using the less invasive and less expensive means of tape and nail traction. These are: the Early Active Vector Adjustable Skin Traction (EAVAST) orthosis (which has no reported issues using tape though it is difficult to perform passive movements as the unaffected hand is required to maintain traction) and the Poole traction orthosis (which is well-established however it can result in nail pain or temporary nail loss).

Clinical reasoning: The literature presents a series of orthoses designs that have pros and cons. The collective goal of a traction orthosis is to ensure that it achieves good reduction, it is low profile, non-invasive and easy to use (i.e. to perform exercises and use in activities of daily living).

Innovative, analytical or new approach: A new dynamic traction orthosis that is non-invasive, low-profile and which is easy to perform exercises in will be illustrated.

Contribution to advancing HT practice: The new design builds upon existing ideas of dynamic traction orthoses with reference to the relevant literature. It presents a blueprint for future research into the merits of this design.