Phalangeal Fractures Treated by Tendinitaxis: A Narrative Review of Principles, Techniques, and Outcomes

Abstract

Phalangeal fractures are common injuries sustained to the hand which frequently lead to stiffness, malunion, and functional compromise due to the close relationship between bone, tendon, and soft tissues with the digital skeleton. Management strategies vary, from immobilization, to closed reduction and open reduction techniques with the goal to restore bony alignment and eventual range of motion and hand function. It is generally accepted that surgical fixation methods, given the additional disruption of surrounding soft tissues, is associated with increased risk of tendon adhesions and potential reduced range of motion outcomes.
Traction of fracture fragments to restore alignment can be achieved externally through skin traction and use of orthoses, internally via fixation apparatus, or a combination of the two with skeletal traction. The restoration of bony alignment is achieved through the principle of tendinotaxis. Tendinotaxis is a principle of fracture reduction that uses tension generated by tendon forces to realign fracture fragments, offering a minimally invasive technique to achieve stable alignment while preserving soft tissue integrity. This narrative review examines the anatomical basis, biomechanics, clinical indications, surgical techniques, and outcomes of tendinotaxis in the management of proximal, middle, and distal phalangeal fractures. Tendinotaxis techniques have shown favorable outcomes in comminuted, intra-articular, and unstable fractures. Evidence suggests that tendinotaxis via traction can effectively restore bony alignment, and minimize surgical soft tissue trauma, restoring normal joint motion. Available literature demonstrates improved range of motion, reduced rates of stiffness, and lower complications as compared with conventional open reduction methods. Further high-quality comparative studies are needed to standardize protocols and define indications. Tendinotaxis remains a valuable technique in carefully selected phalangeal fractures where the preservation of soft tissue and early mobilization are essential to functional recovery.