Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Jan;51(1):14-24.
doi: 10.1177/17531934251350453. Epub 2025 Jun 19.

Clinical outcomes of ligamentotaxis in closed phalangeal fractures: a systematic review

Joaquin Alfonso Palanca  1 , Michalis Hadjiandreou  2 , Fawz Kazzazi  2 , Honey Ghaffari  2 , Matthew Pywell  2 , Gurjinderpal Singh Pahal  2
Affiliations

Clinical outcomes of ligamentotaxis in closed phalangeal fractures: a systematic review

Joaquin Alfonso Palanca et al. J Hand Surg Eur Vol. 2026 Jan.

Abstract

Closed proximal interphalangeal (PIP) joint and proximal middle phalanx fractures can result in considerable functional disability for the patient. Treatment by ligamentotaxis using a dynamic external fixation (DEF) device appears to be the most promising of several available surgical techniques, although there is no clear consensus. This systematic review of the clinical outcomes of ligamentotaxis in patients with closed phalangeal fractures includes 14 studies and 272 patients. The grand mean QuickDASH (12) and DASH (8) scores show that DEF provides excellent functional results for closed phalangeal fractures at the PIP joint. The incidence of postoperative complications is low and similar to other commonly used surgical techniques, including closed reduction percutaneous pinning, with infection (6.6%) and early osteoarthritis (5.9%) being the most common. Further research in the form of randomized control trials are required to determine the best method of treatment.

Keywords: Dynamic external fixation; ligamentotaxis; middle phalanx; phalangeal fractures; proximal interphalangeal joint; proximal phalanx.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Grand mean functional outcome scores.
Figure 3.
Figure 3.
Mean DASH scores all included papers.
Figure 4.
Figure 4.
Secondary outcome complication rates.
Figure 5.
Figure 5.
ROBINS-I risk of bias summary plot.
See this image and copyright information in PMC

References

    1. Abou Elatta MM, Assal F, Basheer HM, Ibrahim MM. The use of a simple dynamic external fixator for the treatment of volar fracture subluxation of proximal interphalangeal joints of the fingers. Tech Hand Up Extrem Surg. 2016, 20: 161–5. - PubMed
    1. Abouelela A, Mubark I, Hassan M, Howells M, Ashwood N, Kitsis C. Mid-term outcomes of unstable complex proximal interphalangeal joint fracture management using the Ligamentotaxor® device: a case series of 33 cases. Cureus. 2020, 12: e10519. - PMC - PubMed
    1. Awad GA, Everton F, Downs M, Chummun S, Wilson SM. Outcomes of the use of Ligamentotaxor® for proximal interphalangeal fractures of the hand: North Bristol Hand Centre experience. Eur J Plast Surg. 2018, 41: 613–6.
    1. Colegate-Stone T, Marenah K, Compson J, Tahmassebi R, Tavakkolizadeh A. Functional outcomes following pilon fractures of the middle phalanx managed with the ligamentotaxor external fixator. Hand Surg. 2015, 20: 285–9. - PubMed
    1. Damert HG, Altmann S, Kraus A, Infanger M, Sattler D. Treatment of intraarticular middle phalanx fractures using the Ligamentotaxor®. HAND. 2013, 8: 460–3. - PMC - PubMed

Publication types

LinkOut - more resources