Background: Traction for phalangeal fractures utilizes the principle of “ligamentotaxis.” In Australia, a number of hand therapists and surgeons have contributed to the design of a skin traction method utilizing rigid sports tape, elastic, and hand-based thermoplastic splint. Aims: The study aims to determine the efficacy and outcomes of skin traction in the treatment of phalangeal fractures in comparison with surgical management. It also aims to define the vectors, force, types of phalangeal fracture, and degree of displacement that skin traction can improve. Method: A retrospective cohort trial is currently underway reviewing outcomes of 103 skin traction cases involving phalangeal and metacarpal fractures performed at the Nepean Hospital in New South Wales over a 3-year period and comparing these to surgical cases. Outcome measures being utilized include total active movement (TAM), grip strength, pain levels, and patient rated wrist and hand evaluation (PRWHE) scores. Radiological analysis is also being undertaken with the intention of developing an algorithm to match the type of fracture with recommended treatment method. We are currently in the process of collecting surgical group data and expect to be able to present this by the time of conference meeting. Results: Preliminary results according to Belsky’s criteria indicate an average of 227.50 total active motion for 54 phalangeal finger fractures treated with the technique. The results were excellent for 37 cases, good for 14 cases, and poor for 3 cases. Grip strength averaged 32.3 kg for the affected limb (99.3% of the non-affected limb). Gingrass criteria for thumb phalangeal outcomes in 6 cases showed average 82.2° TAM for five (5) cases. Excellent outcomes were achieved in 3 cases, and good outcomes were achieved in 2 cases. Pinch strength averaged 4.25 kg and was 79.7% of the non-affected thumb. Conclusion: Skin traction may provide a cost-effective and clinically effective tool for the management of phalangeal fractures.

Background:  It is well recognised that some people with cerebral palsy and other conditions have low energy requirements because they lack mobility and have a low resting energy expenditure (Dickerson et al., 1999). When tube fed, it may be necessary to give a reduced amount of an age appropriate feed to ensure an appropriate energy intake and avoid excessive weight gain, although this may compromise the intake of other nutrients (Skelton et al., 2006). The aim of the survey was to compare prescribed nutrient intake of tube fed clients, who have enteral feeding as their major source of nutrition, with dietary reference values. Methods:  Data on type and quantity of prescribed feeds was collected retrospectively from the case notes of 59 adults and 16 children aged >3 years with a learning disability who have tube feeds as their main source of nutrition. A nutritional analysis of the feed was completed using Microdiet dietary analysis programme, which was compared with the reference values for nutrient intake (Department of Health, 1991) for energy, protein potassium, vitamin D and chloride. Results:  None of the prescribed feeds met the estimated average requirements (EAR) for energy. The level of compliance varied for the other nutrients as shown in Table 1.  Percentage (n) of clients compliant with dietary reference values (EAR/lower reference nutrient intake) Nutrient % Compliance Number compliant Energy00/75Protein2116/75Potassium5642/75Vitamin D00/75Chloride8060/75 Discussion:  Because the energy requirement was often low in this group, and the feed prescribed accordingly, the intake of other nutrients was compromised. Commercial feeds are not always available to meet this client group's needs therefore prescribers must be aware of the potential for deficiencies to occur and it may be necessary to supplement feeds. It was possible that clients needing a very much reduced energy intake may not require as much as the reference nutrient intake for nutrients but there is no research to support this. Conclusions:  The survey showed that the adults and children do not meet the EAR for energy and do not meet the reference nutrient intake/lower reference nutrient intake for some nutrients. Regular assessment, monitoring and follow‐up with appropriate supplementation is necessary to ensure a nutritionally adequate intake. References:  Dickerson, R.N., Brown, R.O., Gervasio, J.G., Hak, E.B. & Hak, L.J. (1999) Measured energy expenditure of tube fed patients with severe neurodevelopmental disability. J. Am. Coll. Nutr.18, 61–68. Skelton, J.A., Havens, P.L. & Werlin, S.L. et al. (2006) Nutrient deficiencies in tube fed children. Clin. Pediatr. 45, 37–41.