The S-Quattro in the management of sports injuries of the fingers

Summary

Intra-articular phalangeal fractures of the small joints of the hand are difficult sports injuries to manage. The Stockport Serpentine Spring System, abbreviated to S-Quattro was developed by the senior author as an external fixator to treat these fractures. We present the largest series of patients with sports injuries treated with the S-Quattro.

Twenty patients with these fractures were treated over a three-year period. The injured joint was distracted after inserting two pins percutaneously into normal phalangeal bone. Two serpentine springs were then inserted between the pins applying distraction to the fracture site. The fixation devices were removed in clinic between 4 and 6 weeks.

Objective analysis revealed an average arc of movement of the affected joint of 94 degrees at an average follow-up of 14 months. The mean DASH score was 5 indicating mild impairment. All of the patients were satisfied with the results and the radiographic appearances were satisfactory.

The S-Quattro is a versatile system that permits some movement of the injured joint while maintaining reduction. It is relatively free of complications with good results. We advocate the routine use of the S-Quattro in view of its inherent simplicity and the good results it produces with these difficult sports injuries.

Introduction

Intra-articular phalangeal fractures of the small joints of the hand are important injuries in terms of the frequency with which they occur in sports. The limited singular plane of motion of the phalangeal joints makes them susceptible to injury, especially with the hand placed in a misjudged position in the path of an oncoming ball.³ The management of these fractures is difficult and challenging.3, 8 If these fractures are not managed satisfactorily, they lead to malunion and joint stiffness. This could have detrimental implications on the sportsman's future performance.

Surgical treatment in the form of Kirschner wire fixation⁶ and intraosseous wiring¹⁴ has been described in literature. Surgery is challenging because the fracture fragments are small and often comminuted. Even if internal fixation is successful in holding the fracture fragments in position, there is a need for joint mobilisation during the healing period to prevent joint stiffness.³ Joint movements are limited by the presence of these internal fixation devices.

Vidal et al.¹⁸ described the principle of ligamentotaxis where traction can reduce displaced and comminuted intra-articular fracture fragments by its action on attached ligaments and capsular structures. Although this enables reduction to a great extent, maintaining reduction whilst simultaneously allowing joint movement until the fracture has united is difficult. Several external fixation techniques that employ this principle have been described with variable results. These include a force couple splint,¹ dynamic longitudinal traction,¹⁵ compass hinge,¹¹ pins and rubber traction system¹⁶ and dynamic springs.¹⁰ None of these methods has gained widespread acceptance due to the complexity of the systems.

The Stockport Serpentine Spring System, abbreviated to S-Quattro was developed as an external fixator to treat intra-articular phalangeal fractures.⁵ It consists of a unique dual, parallel but opposing action spring column system as shown in Fig. 1. It works on the principle of ligamentotaxis. This system was devised by the senior author and has been used successfully for the last 15 years.4, 5, 7 Of those patients suitable for treatment with this technique, over half have sustained their injuries during sports.⁴ We present our case series of 20 patients with these fractures, which were managed with the ‘S’-Quattro. This is the largest series of patients with sports injuries managed with the S-Quattro.