Percutaneous Pinning vs Orthosis and Early Mobilization
Percutaneous Pinning vs Orthosis and Early Mobilization
This study aims at investigating if splinting and early mobilization is a better method,
 regarding range of motion, for treating fractures of the base phalanx of the fingers compared
 to surgery with pinning. This will be achieved through a randomised clinical trial comparing
 the two methods.
Proximal phalangeal fractures of the hand are very common and affect patients of all ages. .
 Most fractures heal without complications but these injuries can result in impaired hand
 function and prolonged inability to work and perform activities of daily living. If there is
 a dislocation that cannot easily be repositioned to a stable position, surgery might be
 required. Surgery is often performed with percutaneous pinning and immobilisation in plaster
 for 4 weeks. Good results of non-surgical treatment with a splint that allows immediate
 mobilization of the interphalangeal joints has been reported. This study will compare these
 two methods for treating fractures of the base phalanx of the fingers. Recruited patients
 will be randomized to one of the two treatment arms: 1. surgery with pinning 2. conservative
 treatment with a splint. Primary outcome is total active range of motion in the affected
 finger at 3, 6 months and 1 , 3 years. Secondary outcomes are number of sick days and various
 patient related outcome measures.
Inclusion Criteria:

 -Fractures of the base phalanx of digit 2-5 in the hand.

 Exclusion Criteria:

 -  Fracture older than 2 weeks.

 -  More than 25° of sagittal plane and/or 10° lateral angulation after reposition.

 -  Intra-articular step >1mm.

 -  Associated fractures in other bones (i e metacarpals, middle and distal phalanges)
 and/or tendon and nerve injuries in any finger.

 -  Open fractures.

 -  Patient age <18 years.

 -  Inability to co-operate with the follow-up protocol (i.e. language difficulties,
 severe psychiatric disorder, cognitive impairment, drug addiction).