An investigation of the acute management of closed intra-articular fractures of the proximal interphalangeal joint in Ireland

Abstract

Purpose Many treatment methods for intra-articular fractures of the proximal interphalangeal (PIP) joint are described in the literature without a consensus on the most effective approach. The purpose of this study was to investigate the methods of treatment of PIP joint fractures being used by trauma surgeons in the Republic of Ireland currently and the timing of referral to therapy. Design/methodology/approach A cross-sectional descriptive study methodology was used to survey trauma surgeons, occupational therapists and physiotherapists in Ireland. An online platform was used. A total of 21 surveys were returned by surgeons and 37 by therapists. Descriptive statistical analysis was used to present the results. Findings Buddy strapping was reported as the primary treatment method for stable PIP joint fractures. All levels of fracture severity were reported to be treated using traction constructs, which include static and dynamic fixation and orthoses. Unstable fractures were managed using open reduction with internal fixation by 50 per cent of surgeons. Early timing of referral to therapy is reported by more surgeons than therapists. The majority of therapists indicated that they did not have the resources to see patients at the optimal time. Originality/value To the authors’ knowledge, this study provides the first description of the management of PIP joint fractures across the Irish health service. The findings of this study suggest that additional therapy resources are required within the health service executive to facilitate the desired early referral to therapy and to enable service development for this category of hand fractures.

Post-operative management of flexor tendon injuries at zone II and flexor pollicis longus – a survey of Irish practice

“…An overall descriptive design (Cresswell, 2014) using a survey format was chosen. Survey methodology provides a useful mechanism for presenting an overview of current interventions to inform practice development and has been used recently in an Irish study of hand therapy practice (Harmon and Spirtos, 2020). The online survey platform, Survey Monkey was used for ease of administration, completion and analysis.…”

Volar Plate Injuries of the Proximal Interphalangeal Joint

“…One study investigating the acute management of closed intraarticular fractures of the PIPJ found that joint mobilization and patient education regarding mobilization were the primary reasons for referral to therapy across all levels of fracture severity. 32 Isolated volar plate avulsion injuries are amenable to early mobilization of the PIPJ with progressive ROM exercises provided the joint is stable. 2 Early mobilization for PIPJ fractures is recommended within the first week, and there is agreement in the literature that flexion exercises of the PIPJ should be commenced soon after injury with extension exercises to follow 2e3 weeks post injury.…”