Dynamic traction for base of proximal phalanx fractures

X-rays show complex fractures of the base of the proximal phalanges of the index and middle fingers. This patient was hit by a snowboarder

As expected the fractures would not reduce into a satisfactory position in plaster

We chose to treat the fractures by external dynamic traction to allow healing whilst retaining finger movement. The wire positions are marked

  First wire half way through the index finger. This was all performed under local anaesthtic i.e. the patient was awake

Wire in the index finger and second wire being placed into the middle finger

Middle finger wire about to be bent

Middle finger wire has been bent. The index finger wire is being bent

The wires have been bent

The bent wires are held togethor for rigidity prior to the traction (pulling out) being applied