Traction splinting (EAVAST protocol) versus operative fixation of proximal phalanx fractures: a comparative study of patient outcomes

Introduction: Phalangeal fractures are common, frequently deformed and unstable, and are regularly managed operatively. However, closed methods of reduction are increasing. This study aimed to compare functional outcomes for a non-operative cohort using a skin traction method developed by the Nepean Hospital, Sydney, Australia, termed ‘early active vector adjustable skin traction’ or EAVAST, compared to operatively managed patients as a potential alternative for the management proximal phalanx fractures. Methods: A prospective cohort study of patients who underwent operative fixation or traction using the EAVAST protocol between January 2018 and January 2020. Patients were managed on a case-by-case basis by fracture type and mechanism of injury. Functional outcomes were assessed at three months post intervention using total active motion, mean strength and QuickDASH scores. Measurements were conducted by independent clinicians with patients wearing gloves to blind the assessor to signs of intervention. Results: Of 38 patients identified for inclusion in the study, 15 underwent operative fixation and 23 underwent traction. There were no significant differences found between the two groups for all outcome measures. The mean total active motion, mean strength and QuickDASH scores for the traction and operative groups were 90.8 per cent versus 90.7 per cent (P = 0.97), 84 per cent versus 79 per cent (P = 0.58) and 1.48 versus 2.5 (P = 0.54), respectively. Conclusions: We found no clinically or statistically significant difference between EAVAST protocol and operative management of proximal phalanx fractures. Future study is now warranted, ideally a multi-centre prospective randomised controlled trial with blinded assessment of outcomes in-cluding a cost–benefit analysis comparing standardised operative and traction techniques.