Static progressive versus three-point elbow extension splinting: a mathematical analysis

Mobilizing orthoses in the management of post-traumatic elbow contractures: A survey of Australian hand therapy practice

STUDY DESIGN

Mixed-methods survey.

INTRODUCTION

Elbow stiffness and contractures often develop after trauma. There is a lack of evidence on mobilizing orthoses and the factors guiding orthotic prescription.

PURPOSE OF STUDY

To investigate hand therapists' orthotic preferences for varying extension and flexion deficits, and describe the factors affecting orthotic choice for post-traumatic elbow contractures.

METHODS

103 members responded to the electronic survey via the Australian Hand Therapy Association mailing list. Five post-surgical scenarios were used to gather information regarding orthotic preferences, reasons and orthotic protocol: (1) week 8 with 55° extension deficit; (2) week 12 with 30° extension deficit; (3) week 12 with 55° extension deficit; (4) week 8 with flexion limited to 100°; (5) week 12 with limited flexion.

RESULTS

Most responders (89.9%) used mobilizing orthoses, predominantly for extension (88.5%). Orthotic preferences for scenarios 1 to 5 were (1) serial static (78.3%); (2) custom-made three-point static progressive (38.8%); (3) custom-made turnbuckle static progressive (33.8%); (4) "no orthosis" (27.9%); and (5) custom-made hinged (27.1%) and nonhinged (27.1%) dynamic. Choices were based on "effectiveness," "ease for patients to apply and wear," and "ease of fabrication/previous experience/comfortable with design." The recommended daily dosage for extension was 6 to 12 hour.

DISCUSSION

This is the first known study that reflects on the use of mobilizing orthoses in post-traumatic elbows in Australia.

CONCLUSIONS

Mobilizing orthoses are used routinely for post-traumatic elbows in Australia. Extension deficits are managed with serial static and static progressive orthoses at weeks 8 and 12, respectively. Research is needed to assess whether orthotic intervention before 12 weeks is beneficial in reducing contractures.

The use of static progressive and serial static orthoses in the management of elbow contractures after complex fracture dislocation injuries: A pediatric case study

INTRODUCTION

Contractures are the most common complication after traumatic injury to the elbow. Although evidence supporting the use of static progressive and serial static orthoses to help recover range of motion after these complex injuries is growing, there is currently a paucity of literature exploring its efficacy in pediatric populations.

CASE DESCRIPTION

The following case study presents the results of the use of static progressive and serial static orthoses with a young patient who presented with both elbow extension and flexion contractures after a complex fracture dislocation injury.

RESULTS

A noted and consistent improvement in both elbow extension and flexion can be observed after commencement of the static progressive and serial static orthoses. These results are consistent with the literature exploring the efficacy of these orthoses with adult populations with traumatic elbow injuries.

DISCUSSION

Further studies evaluating the use of static progressive and serial static orthoses in the management of elbow contractures after traumatic injuries in pediatric populations is needed to establish best practices with this particular patient population.

Efficacy of orthotic devices for increased active proximal interphalangeal extension joint range of motion: A systematic review

STUDY DESIGN

Systematic review.

INTRODUCTION/PURPOSE OF THE STUDY

To determine the efficacy of orthotic devices for increased active proximal interphalangeal (PIP) joint range of motion and optimal wearing schedule of the devices to guide clinical practice. The secondary purpose is to capture the outcome measures used by the authors. The final purpose was to determine if recent studies addressed patient satisfaction and adherence in the orthotic management of a PIP joint injury.

METHODS

A comprehensive literature search was conducted using the search terms splint, orthotic device, hand orthotic, brace, proximal interphalangeal joint, occupational therapy, and physical therapy using PubMed, CINAHL, MEDLINE, and ProQuest. The following data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines: background statement, objectives, data sources, study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings.

RESULTS

Best results were achieved when the PIP orthoses were worn for a longer duration especially for the treatment of extension deficits.

DISCUSSION

Studies that provided a wearing schedule of a minimum of 6 hours obtained the greatest improvements in extension deficits of the PIP joint.

CONCLUSION

Recommended orthotic dosage to treat PIP joint injury is at least 6 hours a day for 8-17 weeks.

Rehabilitation considerations in the management of terrible triad injury to the elbow

An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. This injury almost always renders the elbow unstable requiring surgical intervention. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Recent literature has improved our understanding of elbow anatomy and biomechanics as well as the pathoanatomy of this injury. This article reviews key concepts that will allow the surgeon and therapist to apply an systematic rehabilitation approach when managing such injuries.