Tara L Packham1, Pamela D Ball2, Joy C MacDermid3, James R Bain4, Arianna DalCin4. 1. Hand Therapy Clinic, Department of Rehabilitation Services, Neurosciences and Trauma Program, Hamilton Health Sciences, Hamilton, Ontario, Canada; School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Electronic address: packhamt@hhsc.ca. 2. Hand Therapy Clinic, Department of Rehabilitation Services, Neurosciences and Trauma Program, Hamilton Health Sciences, Hamilton, Ontario, Canada. 3. School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. 4. Department of Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada; Faculty of Health Sciences, Department of Surgery and Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada.
Abstract
INTRODUCTION: Intra-articular hand fractures can have devastating consequences for movement and function. The unique nature of the injury and diverse management strategies are a challenge for conducting trials. PURPOSE OF THE STUDY: To conduct a scoping review of traction constructs for the management of intra-articular hand fractures. METHODS: We conducted a systematic search of the literature, extracting data on the scope and nature of the evidence for traction constructs. RESULTS: Our search yielded 87 articles addressing 3 traction constructs: (1) static traction (n = 17), (2) dynamic external fixation (n = 53), and (3) dynamic orthoses (n = 17). Active range of motion of the target joint was the most frequently reported outcome. Study designs included 36 cohorts, 21 case series, and 9 case studies: 24% contained only technical information. CONCLUSIONS: The current literature addressing traction constructs consists primarily of small and low-quality studies. Evidence synthesis could improve the estimation of range of motion outcomes but would not be able to identify the best treatment. Consensus on classification of fracture patterns, routine use of outcome measures, and randomized trials are needed to compare different traction constructs and inform evidence-based care. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: N/A.
INTRODUCTION:Intra-articular hand fractures can have devastating consequences for movement and function. The unique nature of the injury and diverse management strategies are a challenge for conducting trials. PURPOSE OF THE STUDY: To conduct a scoping review of traction constructs for the management of intra-articular hand fractures. METHODS: We conducted a systematic search of the literature, extracting data on the scope and nature of the evidence for traction constructs. RESULTS: Our search yielded 87 articles addressing 3 traction constructs: (1) static traction (n = 17), (2) dynamic external fixation (n = 53), and (3) dynamic orthoses (n = 17). Active range of motion of the target joint was the most frequently reported outcome. Study designs included 36 cohorts, 21 case series, and 9 case studies: 24% contained only technical information. CONCLUSIONS: The current literature addressing traction constructs consists primarily of small and low-quality studies. Evidence synthesis could improve the estimation of range of motion outcomes but would not be able to identify the best treatment. Consensus on classification of fracture patterns, routine use of outcome measures, and randomized trials are needed to compare different traction constructs and inform evidence-based care. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: N/A.