Dynamic splinting in wrist extension following distal radius fractures

Outcome Analysis of Distal Radius Fracture with Orthosis Versus Cast Immobilization after Palmar Plate Osteosynthesis: A Randomized Controlled Study

Although the benefits of hand orthoses were shown in previous studies, they have not been able to establish themselves in clinical routines. With a focus on patient satisfaction, this study aimed to evaluate the latest generation of hand orthoses after palmar plate osteosynthesis for isolated distal radius fractures in comparison with circular plaster casts. 50 patients (16% dropout rate) were randomly assigned to an orthotic group (immobilization by orthosis, OG) or a control group (immobilization by a plaster cast, CG). Intra-articular fractures were present in 74% of the cases, and unstable AO C3 fractures in 26%. Questionnaires on patient satisfaction, documentation of the time required, clinical scores (DASH, SF-36), range of motion, grip measurements and radiographs were used for evaluation. The OG proved to be equivalent to the plaster treatment in terms of patient satisfaction, and stability of the reduction, as well as clinical scores DASH and SF-36. The OG was even superior in terms of personal hygiene (p = 0.011), handling (p = 0.008) and better adaptability (p = 0.013). Significantly less time was required to apply the orthosis (p < 0.001). In addition to the good results achieved so far, the study showed that the latest generation of orthoses has several advantages over plaster cast therapy, and could therefore become established in everyday clinical practice.

Early functional postoperative therapy of distal radius fracture with a dynamic orthosis: results of a prospective randomized cross-over comparative study

Introduction

This study was conducted according to GCP criteria as a prospective randomized cross-over study. The primary goal of the study was to determine clinical findings and patient satisfaction with postoperative treatment. 29 patients with a distal radius fracture that was surgically stabilized from volar and who met the inclusion criteria were enrolled over a 12-month period. Each patient randomly received either a dorsal plaster splint or a vacuum-fit flexible but blocked orthosis applied postoperatively in the operating theatre to achieve postoperative immobilization. After one week all patients were crossed over to the complementary device maintaining the immobilization until end of week 2. After week 2 both groups were allowed to exercise wrist mobility with a physiotherapist, in the orthosis group the device was deblocked, thus allowing limited wrist mobility. After week 4 the devices were removed in both groups. Follow-up exams were performed after postoperative weeks 1, 2, 4 and 12.

Results and Discussion

Results were determined after week 1 and 2 using SF 36 and a personally compiled questionnaire; after weeks 4 and 12 with a clinical check-up, calculation of ROM and the DASH Score. Comparison of the two groups showed a significant difference in ROM for volar flexion after 4 weeks, but no significant differences in DASH Score, duration of disability or x-ray findings. With regard to satisfaction with comfort and hygiene, patients were significantly more satisfied with the dynamic orthosis, and 23 of the 29 patients would prefer the flexible vacuum orthosis in future.

Trial Registration

German Clinical Trials Register (DRKS) DRKS00006097

Effects of a dynamic progressive orthotic intervention for chronic hemiplegia: a case series

STUDY DESIGN

Case series design on a single subgroup of participants.

INTRODUCTION

Management of hypertonicity and resistance to passive movement (RTPM) in the upper extremity is an intractable problem for persons with stroke and the therapists who provide their care. Therapists have limited options for assessment and treatment of this condition which can profoundly limit functional performance and quality of life.

PURPOSE OF THE STUDY

To evaluate the effect of a 12-week dynamic progressive orthotic intervention in persons with chronic stroke exhibiting wrist flexion contracture who are residents of a long-term skilled nursing facility.

METHODS

A custom-fitted dynamic progressive wrist extension orthotic was applied to 6 residents with chronic stroke. The orthotic was worn for 4 h daily, 4×/week for 12 weeks. Wrist passive range of motion (PROM) and RTPM were measured weekly and after discontinuation of the orthotics using the Modified Ashworth Scale and the Tardieu Scale of Spasticity. Signal analysis of electromyographical (EMG) flexor response to extensor stretching was also measured before and after orthotic intervention using maximal root mean square (RMS) values and EMG burst onset time.

RESULTS

A moderate effect was found for changes in PROM with the orthotic intervention. Progress made diminished following discontinuation. Moderate effects were also seen in EMG measures which indicated increases in amount of resistive-free movement following intervention.

CONCLUSION

A dynamic progressive orthotic intervention can be an effective option for increasing wrist PROM and reducing RTPM in persons with chronic stroke.

LEVEL OF EVIDENCE

4.

Dynamic splints do not reduce contracture following distal radial fracture: a randomised controlled trial

QUESTION

Do dynamic splints reduce contracture following distal radial fracture?

DESIGN

Assessor-blinded, randomised controlled trial.

PARTICIPANTS

Forty outpatients with contracture following distal radial fracture.

INTERVENTION

The control group received routine care consisting of exercises and advice for 8 weeks. In addition to routine care, during the day the experimental group received a dynamic splint, which stretched the wrist into extension but allowed intermittent movement.

OUTCOME MEASURES

The primary outcomes were passive wrist extension and the Patient Rated Hand Wrist Evaluation (PRHWE). The secondary outcomes were active wrist extension, flexion, radial deviation, and ulnar deviation, and the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM). All outcomes were measured at commencement, at the end of 8 weeks of treatment, and at 12 weeks (ie, 1 month follow-up).

RESULTS

The mean between-group difference for passive wrist extension and PRHWE at 8 weeks were 4 deg (95% CI -4 to 12) and -2 points (95% CI -8 to 4), respectively. The corresponding values at 12 week follow-up were 6 deg (95% CI 1 to 12) and 2 points (95% CI -5 to 9). There were no sufficiently important between-group differences for any of the secondary outcome measures at 8 or 12 weeks.

CONCLUSION

It is unclear whether dynamic splints following distal radial fracture have therapeutic effects on passive wrist extension or PRHWE, but they clearly do not have any therapeutic effects on active wrist extension, flexion, radial or ulnar deviation, or on the performance or satisfaction items of the COPM. The ongoing use of dynamic splints following distal radial fracture is difficult to justify.

TRIAL REGISTRATION

ACTRN12608000309381.

STATISTICAL ANALYSIS ON FUNCTIONAL AND RADIOGRAPHIC RESULTS AFTER USE OF LOCKED VOLAR PLATE FOR FRACTURES OF THE DISTAL RADIUS

Objectives: To evaluate the functional results from using a fixed-angle locked volar plate for treating fractures of the distal extremity of the radius, using the DASH (disorders of the arm, shoulder and hand) questionnaire and its radiographic correlation with the Lidström classification. Methods: Thirty patients with unstable fractures of the distal extremity of the radius were evaluated after they had undergone a surgical procedure consisting of open reduction and internal fixation using a fixed-angle locked volar plate, at the Military Police Central Hospital of Rio de Janeiro between 2008 and 2009. The results were assessed based on range of motion, DASH protocol scores and radiographies with the Lidström classification. Results: The mean age of the patients in the study was 51 years. The mean DASH score was 11.9 points. It was observed that the radiographic findings did not influence the DASH score. It was found that flexion, pronation, supination and radial deviation correlated with the DASH score. Conclusions: The study showed that subjective functional outcomes using the DASH protocol, obtained from using a locked volar plate to treat fractures of the distal extremity of the radius, are influenced by the range of motion, and especially by the flexion, supination, pronation and radial deviation of the wrist after surgery. There is no correlation between the radiological parameters of either the normal or the operated radius, and the subjective functional outcomes assessed using the DASH protocol.

Dynamic splinting for paediatric contracture reduction of the upper limb

Background

This report is based on a case of ‘shaken baby syndrome,’ and clinical manifestations of this injury often include hypertonicity, spasticity and joint contracture. Shaken baby syndrome affects over 1 million children and resembles symptoms of traumatic brain injury.

Methods

The patient was a five-year-old boy who had suffered a traumatic brain injury with right spastic hemiplegia. Over the course of treatment, multiple modalities were used to manage his tone, spasticity and to reduce wrist and elbow contractures, which included Botox® (Allergan Co., Irvine, CA, USA), manual therapy and dynamic splinting as home therapy. The main outcome measured was change in maximal range of motion(s) (ROMs) in the elbow and wrist.

Results

After dynamic splinting was initiated, the child's passive ROM increased by 65° in wrist extension and 45° in elbow extension. Ulnar deviation progressed by 15–30°.

Conclusion

Dynamic splinting contributed over 900 hours of end-range, home therapy for wrist extension and 700 hours in end-range home therapy for elbow extension. It is hypothesized that this prolonged duration of passive stretching at the end-range is responsible for the substantial gains in ROM.