Steroid versus placebo injections and wrist splints in patients with carpal tunnel syndrome: a systematic review and network meta-analysis

A network meta-analysis of randomized controlled trials compared the effectiveness of corticosteroid injections with placebo injections and wrist splints for carpal tunnel syndrome, focusing on symptom relief and median nerve conduction velocity. Within 3 months of the corticosteroid injection, there was a modest statistically significant difference in symptom relief compared to placebo injections and wrist splints, as measured by the Symptom Severity Subscore of the Boston Carpal Tunnel Questionnaire; however, this did not meet the minimum clinically important difference. Pain reduction with corticosteroids was slightly better than with wrist splints, but it also failed to reach clinical significance. Electrodiagnostic assessments showed transient changes in distal motor and sensory latencies in favour of corticosteroids at 3 months, but these changes were not evident at 6 months. The best current evidence suggests that corticosteroid injections provide minimal transient improvement in nerve conduction and symptomatology compared with placebo or wrist splints.

Outcomes of glenohumeral dysplasia after brachial plexus birth injury using the Sup-ER orthosis

We investigated the efficacy of the supination-external rotation ('Sup-ER') orthosis, designed as a non-operative treatment to maintain normal anatomical growth of the shoulder, on the progression of glenohumeral dysplasia in patients with brachial plexus birth injuries. The Sup-ER orthosis was fabricated for 20 infants diagnosed with glenohumeral dysplasia after brachial plexus birth injuries and its success in correcting glenohumeral dysplasia was confirmed by objective calculations of the alpha angle on serial ultrasound findings and improvement in Active Movement Scale scores. Of the 20 patients, 14 had successful resolution of glenohumeral dysplasia, confirmed by shoulder abduction, shoulder flexion, external rotation and supination, Active Movement Scale scores and improving alpha angle measurements. Failure to rectify glenohumeral dysplasia, evidenced by worsening ultrasound findings and Active Movement Scale scores, necessitated a change to operative management in six patients.Level of evidence: IV.

Non-surgical correction of knee flexion deformity in persons with haemophilia: A staged multidisciplinary approach

INTRODUCTION

Flexion deformity of the knee is a common complication following recurrent haemarthrosis in persons with haemophilia (PWH) on episodic factor replacement therapy, restricting independent mobility. There is limited literature on the comprehensive management of this condition. This report provides the outcome of a staged multidisciplinary approach for the correction of knee flexion deformity (KFD) even in limited resource settings.

PATIENTS AND METHODS

The data of 49 consecutive PWH who were treated for KFD were analysed. The approach included graded physical therapy (PT), followed by serial casting and/or mobilisation under anaesthesia (MUA). MUA was done in carefully selected knees. Surgical correction was opted when non-surgical methods failed.

RESULTS

Of the 49 patients (55 knees), with a median KFD of 40 degrees (range: 10-90), 26/55 (47%) were corrected by graded PT. With serial casting, 9/19 (47%) knees had their KFD corrected. MUA was done for 11 knees of which five achieved correction (45%). Surgical correction was required for only seven knees (12.7%). Following this approach, KFD improved from 40 degrees (range: 10-90) to 15 degrees (range: 0-40), with only minor loss of flexion from 105 (range: 60-155) to 90 degrees (range: 30-150). Out of 55 KFD, 46 (83.6%) KFD were corrected; non-surgical, 39 (70.9%) and surgery, seven (12.7%). The remaining patients (nine KFD; 16.4%) were able to achieve their functional goal despite not meeting the correction criteria.

CONCLUSION

This study shows that in PWH, functionally significant KFD correction can be achieved in about 71%, through non-surgical methods, even without prophylactic factor replacement.

Validation of Temperature Sensors to Monitor Thermoplastic Splint Wear in Hand Surgery Patients

BACKGROUND

The aim of this study was to validate the use of temperature sensors to accurately measure thermoplastic volar forearm splint wear in a healthy cohort of volunteers using 5- and 15-minute temperature measurement intervals.

METHODS

A prospective diagnostic study was performed to evaluate the diagnostic accuracy of temperature sensors in monitoring splint wear in 8 healthy volunteers between December 2022 and June 2023. Temperature sensors were molded into thermoplastic volar forearm splints. Volunteers who were familiar with the study aims were asked to keep an exact log of the time spent wearing the splint ("actual wear time"). Sensors recorded temperatures every 5 or 15 minutes, and separate algorithms were developed to determine the sensor-detected wear time compared with the actual wear time as the gold standard. The algorithms were then externally validated with the total population.

RESULTS

The 5-minute and 15-minute algorithms demonstrated excellent sensitivity (99.1% vs 96.6%), specificity (99.9% vs 99.9%), positive (99.4% vs 99.5%) and negative (99.9% vs 99.3%) predictive value, and diagnostic accuracy (99.8% vs 99.3%), respectively. The 5-minute algorithm recorded 99.5% of the total splint hours, whereas the 15-minute algorithm recorded 96.1%. There was no significant difference between the actual time per wear session (5.4 ± 2.7 hours) and the time estimated by the 5-minute algorithm (5.4 ± 2.6 hours; P = .40), but there was a significant difference for the 15-minute algorithm (5.2 ± 2.6 hours; P < .001).

CONCLUSION

Temperature sensors can be used to accurately monitor thermoplastic volar forearm splint wear.

LEVEL OF EVIDENCE

Diagnostic II.

Customizable Hyperextension Splint for Mallet Finger

Introduction

Mallet finger is a common deformity occurring due to the traumatic detachment of the extensor tendon at its insertion in the distal phalanx. Despite several different methods of splinting being available, residual extensor lag remains one of the most common complications of conservative treatment.

Technique Report

We demonstrate a novel technique to make a hyperextension splint which can be customized as per the individual. The pictorial demonstration depicts every step in the preparation, application, and maintenance of the splint.

Conclusion

We believe that the use of such easily accessible materials and visual demonstration of each step, with pointers along the way to verify the correct technique, will empower any medical professional, to satisfactorily treat such injuries at the primary point of contact, without necessitating the services of a hand surgeon.

Self-Assisted Finger Stiffness Splint (SFSS)

Finger stiffness may arise from injuries, surgeries, or hand-related medical conditions, impacting hand function and overall well-being in daily life. Rehabilitation and hand therapy play a crucial role in restoring optimal range of motion, strength, and functionality. This article introduces the Self-Assisted Finger Stiffness Splint (SFSS), a dynamic splint designed for active finger movement applicable in post-trauma or postoperative rehabilitation. SFSS empowers patients to perform self-administered stretching exercises, expediting recovery and improving compliance. Its versatility extends to postoperative rehabilitation, covering cases like tenolysis of extensor tendons or rehabilitation after fracture healing. While particularly effective for proximal interphalangeal joint (PIPJ) and metacarpophalangeal joint (MCPJ) stiffness, SFSS remains valuable for managing isolated finger stiffness and proves beneficial in addressing multiple-digit stiffness.

A Comparative Study of Effectiveness of Splinting and Splinting Plus Local Corticosteroid Injection in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial

Introduction Corticosteroid injection and wrist-hand splint are two of the most commonly used conservative options for the management of carpal tunnel syndrome (CTS). This study compares the effectiveness of splinting and splinting plus local steroid injection in improving clinical and nerve conduction findings of patients with CTS. Methods A total of 44 patients with CTS were randomized into two groups. Group A used a full-time neutral wrist splint and group B was injected with 20 mg of triamcinolone acetonide and was given a full-time neutral wrist splint for 12 weeks. Clinical and nerve conduction findings of the patients were evaluated at baseline, 4 and 12 weeks after interventions. The chi-square test was used to test the association of different study variables. Z-test was used to test the significant difference between the two proportions. The means were compared by t-test. ANOVA was used to compare more than two mean values. Results The mean difference of the Boston Carpal Tunnel Questionnaire and median nerve latency at baseline and 12th week after treatment was significantly higher in group B than in group A (p<0.05). In intragroup comparison, there was significant improvement in the patient satisfaction, and clinical and nerve conduction values between the baseline level and 4 weeks after intervention and between the baseline and 12 weeks after intervention (P < 0.01). However, the inter-group comparisons were not significant. Conclusion Both of the management methods (splinting plus corticosteroid injection and splinting) have significant effects on the improvement of symptoms, and functional and nerve conduction status. It seems that splinting plus corticosteroid injection has a little edge over splinting alone during the follow-up periods.

Functional Hand-Based Splint in the Treatment of Metacarpal Fractures

Background: Post-treatment stiffness remains a significant hurdle following treatment for displaced or minimally displaced metacarpal fractures. Treatment goals should focus on a stable and acceptable reduction, minimal patient morbidity, and optimal mobility. Methods: A retrospective review of all non-operative metacarpal fractures over a five-month period at a tertiary center hand clinic treated with a hand-based splint were reviewed for radiologic and clinical stability. The splint allowed metacarpophalngeal joint, interphalangeal joint, and radiocarpal joint motion. Data collected included age, handedness, type and location of fracture, occupation, and ability to continue working. Radiologic images were reviewed by a radiologist not otherwise involved in patient care. Results: Thirty-three patients were reviewed with a total of 39 fractures of the second, third, fourth, and fifth metacarpals. Nine patients had nondominant hand fractures while 24 were dominant hand injuries. Twenty out of 24 patients employed pre-injury were able to continue working without missing any days. Three patients were lost to the final follow-up. The average splint duration was 24 days. Twenty-seven of 30 patients showed no change in alignment from start of splinting to end, while three showed some change but remained within non-operative criteria. Conclusion: A hand-based functional splint for metacarpal fractures allows for excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintains functional motion throughout treatment. It can be applied to any non-operative fracture of the second through the fifth metacarpal.

Outcome Differences between Conservatively Treated Acute Bony and Tendinous Mallet Fingers

INTRODUCTION

Tendinous and bony mallets are very different injuries that present with extensor lag at the distal interphalangeal joint. This study aimed to evaluate the differences in outcomes between acute bony and tendinous mallet fingers treated conservatively with splints.

MATERIALS AND METHODS

We retrospectively collected data on patients with acute tendinous or bony mallets who received conservative treatment in our occupational therapy clinic. The patients were examined at an outpatient clinic, where data on pain, extension lag, and loss of flexion were recorded. Outcomes were classified according to the criteria described by Crawford.

RESULTS

Data were collected from 133 patients (43 with bony and 90 with tendinous mallets). We found that bony mallet patients were predominantly younger (mean, 36 vs. 46 years), and more likely to be female (60% vs. 34%), than tendinous mallet patients. We also found that tendinous mallet injuries predominantly affected the middle and ring fingers, while bony mallet injuries predominantly affected the ring and little fingers. The initial extensor lag was worse in tendinous than in bony mallets (median, 28° vs. 15°). In addition, patients with bony mallets had significantly better outcomes with regard to the extension lag (median 0° vs. 5° p = 0.003) and the Crawford Criteria Assessment (p = 0.004), compared with those with tendinous mallets.

DISCUSSION

Mallet injuries, both tendinous and bony, are common. They are often studied together and typically treated in the same manner using extension splints. However, evidence clearly shows that these are different injuries which present in the same manner. This study reinforces these findings and suggests that the outcome of conservative treatment is better for bony than for tendinous mallet fingers.

Objective Methods of Monitoring Usage of Orthotic Devices for the Extremities: A Systematic Review

Orthoses are commonly prescribed to relieve symptoms for musculoskeletal and neurological conditions; however, patients stop wearing orthoses as recommended for many reasons. When considering the effectiveness of orthoses, there needs to be an objective way to monitor whether participants wear the orthosis as instructed, because if this is not followed, the orthoses will not work as intended. This review aimed to identify, summarise, and compare objective methods used to measure compliance with orthoses applied to the extremities. Databases (Scopus, Web of Science, Embase, CINAHL, and MEDLINE) were searched for eligible studies. Twenty-three studies were accepted in the final review, including five studies that employed upper limb orthoses, two that employed hip orthoses, and fifteen that employed lower limb orthoses. To measure compliance objectively, studies utilised temperature sensors, pressure sensors, accelerometers, a step counter, or a combination of sensors. All sensor types have their own advantages and disadvantages and should be chosen based on study-specific parameters. Sensor-derived monitoring provides quantitative, objective data that are beneficial in both clinical and research settings. The ideal solution to monitoring compliance would consist of both objective and user-reported aspects that, in combination, would provide an all-encompassing picture of the orthotic treatment prescribed.

Multiple Bony Mallet Finger Injuries in One Hand of a 14-Year-Old Boy

Bony mallet finger injuries, commonly seen as isolated incidents, typically occur in active individuals. We report a rare case of simultaneous avulsion fractures at the distal phalangeal bases of the second, third, and fourth fingers on the right hand of a 14-year-old boy following a forced passive flexion injury during a football game. The patient initially received conservative management with a finger extension splint for the distal interphalangeal (DIP) joints. However, one week after the injury, we performed surgical fixation on all affected digits using the K-wire extension block method due to multiple fractures and the patient's intolerance for the mallet finger splint. After six weeks, all K-wires were removed, and physiotherapy sessions began. Three months post-injury, the second and fourth DIP joints demonstrated an "Excellent" outcome, and the third DIP joint demonstrated a "Good" outcome based on Crawford's criteria for outcome assessment of mallet finger injury after management. This case highlights the importance of early detection and appropriate management of concomitant mallet finger injuries in pediatric patients to prevent potential complications that could impair hand function and quality of life.

Advantages of FDM and gamma irradiation to manufacture personalized medical devices for airway obstructions

In the early childhood population, congenital airway conditions like bronchomalacia (BM) can pose a life-threatening threat. A breakthrough technology called additive manufacturing, or 3D printing, makes it feasible to create a biomedical device that aids in the treatment of airway obstruction. This article describes how a polycaprolactone (PCL) splint for the upper airways can be created using the fusion deposition technique (FDM) and sterilized using gamma radiation. It is presented as a simple, accessible, and cost-reduced alternative that complements other techniques using more expensive and sophisticated printing methods. Thermomechanical and morphological analysis proved that FDM and sterilizing by gamma irradiation are both appropriate methods for producing splints to treat life-threatening airway blockages. Additionally, the 3D-printed splints' effectiveness in treating a young patient with BM that was life-threatening was assessed by medical professionals. In this regard, the case report of a patient with 34 months of follow-up is presented. Splints manufactured by this affordable 3D printing method successfully surpass breathing arrest in life-threatening airway obstruction in pediatric patients. The success of this procedure represents a fundamental contribution to the treatment of the population in countries where access to expensive and complex technologies is not available.

Extrusive luxation. Therapeutic procedure

Repositioning a traumatized tooth involves replacing and stabilizing it. When it is not possible, a method has been developed by an acetate splint. After few weeks, the tooth was aligned and correctly positioned.

Abstract

Repositioning a traumatized tooth involves, first, replacing and second stabilizing it. Stabilization, on the other hand, usually requires flexible splints. Occasionally the immediate replacement may be impossible being necessary to use other procedure. When complete replacement is not possible.

Initial therapeutic approaches for orofacial myofascial pain: three pilot studies

OBJECTIVE

Myofascial pain diminishes the stomatognathic function and hinders clinical diagnosis. Therefore, initial pain reduction is crucial before definitive treatment. Here, the clinical validity of non-pharmaceutical therapies, including the Aqualizer® splint, physiotherapy, and dry-needle acupuncture was comparatively assessed.

METHODS

Myofascial pain patients (n = 28; 20-65 years old) were examined through a visual analog scale, and intra- and extra-oral muscle palpation. Mandibular maximum opening and neck mobility were also evaluated. Changes in parameters through time were analyzed via the Kruskal-Wallis test, while the Friedman test and dot-plots were used for comparative therapies assessment. General patient improvement was represented via an isometric Principal Component.

RESULTS

The Aqualizer® and physiotherapy resulted in improvement of all parameters except for mouth opening. Acupuncture improved extra-oral muscle pain and neck mobility.

CONCLUSION

The Aqualizer®, physiotherapy, and oral acupuncture are effective initial pain therapies. Among all, physiotherapy provided the greatest benefits, followed by the Aqualizer®.

Two Types of Management for the Noninvasive Treatment of Pectus Excavatum in Neonatal Puppies-Case Reports

Pectus excavatum is a deformity of the thorax characterized by ventrodorsal narrowing of the sternum bone and costal cartilages, which can lead to compression and cardiopulmonary alterations in dogs, presenting a high prevalence in brachycephalic breeds. The aim of this report was to describe two types of management for the noninvasive treatment of pectus excavatum in newborn puppies of the breeds French Bulldog and American Bully. The puppies presented dyspnea, cyanosis and substernal retraction during inspiration. The diagnosis was performed by physical examination and confirmed by chest X-ray. Two types of splints were performed (a circular splint with plastic pipe and a paper box splint on the chest), aiming at thoracic lateral compression and frontal chest remodeling. The management was effective for the conservative treatment of mild-grade pectus excavatum, resulting in the repositioning of the thorax and improvement of the respiratory pattern.

The management of developmental dysplasia of the hip in children aged under three months : a consensus study from the British Society for Children's Orthopaedic Surgery

AIMS

A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children's Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening.

METHODS

A Delphi consensus study was performed among the membership of BSCOS. Statements were generated by a steering group regarding aspects of the management of DDH in children aged under three months, namely screening and surveillance (15 questions), the technique of ultrasound scanning (eight questions), the initiation of treatment (19 questions), care during treatment with a splint (ten questions), and on quality, governance, and research (eight questions). A two-round Delphi process was used and a consensus document was produced at the final meeting of the steering group.

RESULTS

A total of 60 statements were graded by 128 clinicians in the first round and 132 in the second round. Consensus was reached on 30 out of 60 statements in the first round and an additional 12 in the seond. This was summarized in a consensus statement and distilled into a flowchart to guide clinical practice.

CONCLUSION

We identified agreement in an area of medicine that has a long history of controversy and varied practice. None of the areas of consensus are based on high-quality evidence. This document is thus a framework to guide clinical practice and on which high-quality clinical trials can be developed.Cite this article: Bone Joint J 2023;105-B(2):209-214.

The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial

BACKGROUND

Trigger finger is the most common flexor tendinopathy affecting the general population. We evaluated the effects of adding a static metacarpophalangeal joint splint to corticosteroid injection for the management of trigger finger in the short term.

METHODS

We carried out a randomized controlled trial with two parallel arms in Department of Physical Medicine and Rehabilitation at a university hospital. We randomly allocated 60 participants (34 women) with trigger fingers other than the thumb to two groups (both n = 30). The mean (SD) age was 41.5 (7.6) years. All participants received a single injection of 40 mg methylprednisolone plus 0.5 ml of lidocaine at the A1 pulley. Patients in the splint group wore a full time static splint for blocking the metacarpophalangeal joint for 3 months. The primary outcome was the Numerical Pain Rating Scale and the secondary outcomes were Boston questionnaire scores for symptom severity and functional status, grip strength, and the stages of stenosing tenosynovitis. We measured the outcomes at baseline, and in 1 and 3 months post-intervention.

RESULTS

Both interventions were effective; however, the splint group showed more reductions in pain (p = 0.013) and symptom severity (p = 0.047) and a larger decrease in the stages of tenosynovitis (p = 0.004) after 3 months. There was no significant difference in decreasing functional scores between the groups (p = 0.162). The splint group had a better (but not statistically significant) restoring grip strength (p = 0.056).

CONCLUSION

Wearing of a static metacarpophalangeal joint splint for 3 months following a single injection of corticosteroid increases and stabilises the benefits of the treatment for trigger finger.

Three-Dimensional Comparison of the Maxillary Surfaces through ICP-Type Algorithm: Accuracy Evaluation of CAD/CAM Technologies in Orthognathic Surgery

PURPOSE

This retrospective study aims to compare the accuracy of two different CAD/CAM systems in orthognathic surgery. The novelty of this work lies in the method of evaluating the accuracy, i.e., using an Iterative Closest Point (ICP) algorithm, which matches a pair of 2D or 3D point clouds with unknown dependencies of the transition from scan s_(k) to scan s_(k+1).

METHODS

The study population was composed of ten patients who presented to the Maxillofacial Surgery Department of the University "Sapienza" of Rome for the evaluation and management of skeletal malocclusions. The patients were divided into two groups, depending on the technique used: group 1: splintless group (custom-made cutting guide and plates); group 2: splint group (using a 3D-printed splint). STL files were imported into Geomagic^® Control X™ software, which allows for comparison and analysis using an ICP algorithm. The RMSE parameter (3D error) was used to calculate the accuracy. In addition, data were compared in two different patient subgroups. The first subgroup only underwent a monobloc Le Fort I osteotomy (p-value = 0.02), and the second subgroup underwent a Le Fort I osteotomy associated with a segmental osteotomy of the maxilla (p-value = 0.23).

RESULTS

Group 1 showed a 3D error of 1.22 mm ± SD 0.456, while group 2 showed a 3D error of 1.63 mm ± SD 0.303. These results have allowed us to compare the accuracy of the two CAD/CAM systems (p-value = 0.09).

CONCLUSIONS

The ICP algorithm provided a reproducible method of comparison. The splintless method would seem more accurate (p-value = 0.02) in transferring the surgical programming into the operating room when only a Le Fort I osteotomy is to be performed.

Conservative Treatment for Metatarsus Adductus, A Systematic Review of Literature

There are various treatment approaches for the subjects with metatarsus adductus, including nonsurgical and surgical treatment. Nonsurgical treatments such as serial casting, modified shoes (Bebax shoe, Ipos antiadductus shoe) and orthoses (Wheaton brace, counter rotation system splint, Denis Brown bar, and Fillauer bar) are widely used in this regard. The main question posted here is which orthoses are more effective in correcting metatarsus adductus. Therefore, the aim of this review was to determine the efficiency of various nonsurgical treatments used for metatarsus adductus. MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trial, Cochrane Data base of systematic review (CDSR), Scopus and ISI Web of knowledge (from 1960 to 2021) were searched by predefined search strategies to screen eligible randomized controlled studies meeting established criteria. The quality of the studies was assessed based on Down and Black tool. 200 studies on this topic were reviewed and finally 11 studies which met the inclusion criteria were selected for final analysis. These studies evaluated the efficiency of nonsurgical treatment options on foot angle and deformity correction in the subjects with metatarsus adductus. Quality of the papers based on Downs and Black tool varied between 13 and 23. Some treatments such as Wheaton brace, rigid strap, exercise (manipulation), reverse last shoe and plaster cast are used for these subjects. Although good correction can be achieved with use of these treatment methods, some of them have complications which should be considered in this regard. It seems that Wheaton brace and Bebax shoe have fewer complications compared to other methods.

Personalized 3D-Printed Bioresorbable Airway External Splint for Tracheomalacia Combined With Congenital Heart Disease

Severe tracheomalacia (TM) patients with respiratory symptoms need surgical intervention, including aortopexy, internal stents or external splint. While some patients continue to have respiratory symptoms after tracheal relief, and there is no evidence to support any one surgery therapy over another. Here we introduce a clinical safety and efficacy of the three-dimensional (3D)-printed bioresorbable airway external splints in treating congenital heart disease (CHD) patients with severe TM. From May 2019 to September 2020, nine patients with severe TM were enrolled. The median age was 5 months (range, 3–25 months), and the median weight was 7.5 kg (range, 3–15 kg). All patients had wheezing, and two patients were assisted by machine ventilation (MV) preoperatively. The median length of TM was 1.5 cm (range, 1.0–3.0 cm). All patients underwent suspension of a “C”-shaped lumen airway external splint, which were designed in SOLIDWORKS and made of polycaprolactone (PCL). The airway external splint could provided effective support for at least 6 months and was completely degraded into carbon dioxide and water within 2–3 years. The median time of postoperative machine assisted ventilation was 23.7 h (range, 3.3–223.4 h), and the median time of ICU stay was 9 days (range, 4–25 days). The median follow-up time was 18 months (range, 12–24 months). Respiratory symptoms were all relieved, and no external splint-associated complications occurred. The 3D computed tomography reconstruction showed no airway stenosis. Personalized 3D-printed bioresorbable airway external splint can not only limit external compression and prevent airway collapse but also ensure the growth potential of the airway, which is a safe, reliable and effective treatment for CHD with TM.

Tape Splint Tarsorrhaphy for Persistent Corneal Epithelial Defects

PURPOSE

To report outcomes of tape splint tarsorrhaphy (TST) for persistent corneal epithelial defects (PCED).

DESIGN

Retrospective, interventional case series.

METHODS

The study population was consecutive patients with a PCED (14 days or longer) treated at a tertiary cornea clinic with TST. Patients with a corneal epithelial defect that did not respond to treatment with a bandage contact lens were included. Patients with a follow-up time of less than 3 months were excluded. Time to PCED resolution was the main outcome measure.

RESULTS

Thirty-four eyes of 33 patients (mean age 62.9 ± 17.8 years; range, 27-90 years) were included in this study. The main etiologies of the PCED were post keratoplasty (n = 15), herpes simplex virus (n = 4), superficial keratectomy (n = 3), neurotrophic cornea (n = 4), fungal keratitis (n = 2), exposure keratopathy (n = 2), failed graft (n = 1), peripheral ulcerative keratitis (n = 1), rosacea (n = 1), and stitch abscess (n = 1). Mean ± SD time from PCED presentation to TST was 58.9 ± 106.3 days (range, 14-390 days). The mean ± SD area of the PCED was 25.1 ± 15.7 mm² (range, 0.50-42.0 mm²). After TST, resolution of the PCED was achieved in 29/34 eyes (85.3%) without the need for additional interventions within 22.5 ± 24.3 days (range, 2-105 days). The mean ± SD logMAR best-corrected visual acuity improved significantly from 1.11 ± 0.41 to 0.83 ± 0.70 (P = .02). There were no complications attributed to TST and 2 patients elected to discontinue due to discomfort.

CONCLUSIONS

TST achieved resolution of PCEDs secondary to various etiologies in 85.3% of eyes, with significant improvement in vision demonstrated. This simple, inexpensive, noninvasive technique may be considered for patients with PCEDs.

Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common upper extremity compression neuropathy. Non-operative interventions are usually the first-line treatments, and surgery is reserved for those that do not achieve a satisfactory symptom state by non-operative means. This narrative review summarizes the current evidence regarding the efficacy of orthoses, corticosteroid injections, platelet-rich plasma injections, Kinesio taping, neurodynamic techniques, gabapentin, therapeutic ultrasound, and extracorporeal shockwave therapy in people with CTS. While many trials suggest small short-term benefits, rigorous evidence of long-term patient-important benefits is limited. To improve the utility of healthcare resources, research in this area should focus on establishing efficacy of each treatment instead of comparing various treatments with uncertain benefits.

Prospective Multicenter Randomized Controlled Trial Comparing Early Protected Movement and Splinting for Fifth Metacarpal Neck Fracture

BACKGROUND

Fifth metacarpal neck fractures account for 20% of all hand fractures, yet there remains debate with respect to management, particularly when conservative treatment is initiated. The objective of this study is to compare functional and patient-reported outcomes (PROs) in patients treated with early protected movement or splint immobilization.

METHODS

This national multicenter prospective randomized controlled trial compared 2 groups; elastic bandage with early protected movement versus immobilization with splinting. Demographic characteristics were collected at baseline. Functional outcomes (grip strength testing) and PROs (Brief Michigan Hand Questionnaire [bMHQ]) were collected at 4, 8, and 12 weeks post-intervention. Grip strength values of the injured hand were normalized to both the non-injured hand (at baseline), and the Canadian reference values.

RESULTS

Thirty-seven participants from 5 Canadian centers were randomized into the splint (n = 21) or elastic bandage group (n = 16). There were no significant differences in the bMHQ score between the splint (52.1 ± 27.2) or the elastic bandage (46.6 ± 20.4) groups (P = .51). There were no differences in baseline grip strength between the splint (15.3 ± 8.9 kg) and elastic bandage (19.9 ± 7.5 kg) groups. At 8 weeks, the elastic bandage group had a significantly higher grip strength than the splint group (93% vs 64%, respectively: P < .05), when standardized as a percentage of the Canadian reference values.

CONCLUSION

Patients with Boxer's fractures treated with early protected movement had better functional outcomes by 8 weeks post-treatment as compared to the Canadian reference values of those treated with immobilization and splinting. Providers should manage Boxer's fractures with early protected movement.

Management of Gartland Type 1 Supracondylar Fractures: A Systematic Review

PURPOSE

Gartland Type 1 supracondylar humerus fractures are stable, non-displaced injuries treated with non-operative management. This systematic review was performed to gather evidence on the optimal form of immobilization to treat these fractures.

METHODS

The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was performed in November 2020. Articles were eligible if they included children less than 18 years old, with non-displaced supracondylar fractures, treated non-operatively. Randomized trials, quasi-experimental trials, and prospective cohort studies were included. Outcomes of interest included fracture displacement, pain control, time to return to normal activities, return of range of motion (ROM), child/parent satisfaction, adverse events, and cost. Risk of bias was assessed using the Newcastle-Ottawa scale, Rob-2, and the ROBINS tools.

RESULTS

After duplicate records were removed, 525 records were evaluated with 9 studies meeting the inclusion criteria and 5 reporting clinical outcomes. The studies were heterogenous, in intervention and outcomes, and all at moderate risk of bias. Within the available evidence there were no cases of fracture displacement. Two small studies suggested that cuff and collar treatment provided inadequate pain control and delay in return to normal activities, compared to posterior splints. Two randomized control trials (RCTs) suggested that soft fiberglass casts reduced appointment time and increased parent satisfaction, compared to traditional casts. No studies directly compared posterior splints to circumferential casts.

CONCLUSION

There is insufficient high-quality evidence to determine the optimal conservative treatment for patients with Gartland type 1 supracondylar fractures. Level of Evidence Level II systematic review of Level II studies.

SYSTEMATIC REVIEW REGISTRATION

[PROSPERO], identifier [CRD42020144616].

The use of orthoses in the treatment of carpal tunnel syndrome. A review of the literature from the last 10 years

Introduction

A review of the literature from the last 10 years quite clearly shows that immobilization of the wrist in the splint (orthosis) is the most effective, initial method of conservative treatment of carpal tunnel syndrome (CTS). The particular advantages of the described method of treatment are: availability, low cost, good patient tolerance, simplicity and minimal incidence of complications.The aim of this study was to try to define the criteria of proceeding with the selection of the type of orthosis and the duration of its use depending on the clinical condition and the patient's expectations.

Methods

The PubMed electronic database was searched for appropriately selected studies published between 2012 and 2022. The search strategy used was based on the following keywords: carpal tunnel syndrome, immobilization, orthosis, conservative treatment. The authors also searched the cited literature on relevant research and review papers on potentially relevant topics related to conservative treatment of the CTS.

Conclusions

Immobilization in an orthosis gives therapeutic effects in all patients, regardless of the stage of the carpal tunnel syndrome.Most often the orthosis is only used at night for several weeks. During the exacerbation of symptoms, it can also be used during the day during activities that increase symptoms.In practice, it is recommended to wear a splint that immobilizes the wrist in a neutral position or slightly extended at 0-15 degrees (most often 0-5 degrees).A splint immobilizing the wrist and the 2-5 metacarpophalangeal joints are recommended for patients with positive Berger test results.There are no statistically significant differences in the treatment results between individual and traditional orthoses.No statistically significant differences were observed in the treatment effects between rigid and soft orthoses.

Comparison of different treatment techniques in the mandibular condyle fracture

BACKGROUND

Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures.

METHODS

Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment.

RESULTS

The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion.

CONCLUSION

The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.

Clinical trials of 3D printing splints to avoid contracture development in burned children

Background/aim

We evaluated the feasibility of producing splints with 3D printer technology to prevent contractures in burned children in our clinical prospective study.

Materials and methods

After approvals, children with burns greater than 2nd degree were included in the study. Age, sex, burn percentages, printing time, filament types, number of filament trials, splint suitability, patient and doctor comments, preclinical trials’ significances and financial impact were evaluated statistically.

Results

Seventy-six trials were conducted on 18 patients. Fourteen of the patients were male and 4 are female. Average ages of boys and girls were 5 and 3, respectively. Burn percentage was 36.9 ± 13. Polylactic acid (PLAFlex), polyurethane (PolyFlex), semiflexible copolyester (nGenFlex), and thermoplastic polyurethane (TPU) were the main filaments that were used in the study. Printing time differed from 4 to 29 h according to body regions. Splints were suitable for 81.25% in upper extremity, for 66.7% in lower extremity, and for 100% in mouth. Burn percentage was significantly correlated with total number of filament (p = 0.049). Other statistical evaluations were insignificant.

Conclusion

The 3D printer seems to be useful in children with burns. However, difficulties caused by some reasons like production must be overcome. By increasing clinical experience, this emerging custom-made technology may become standard, and documented problems can be solved.

Release of Bisphenol A from Milled and 3D-Printed Dental Polycarbonate Materials

Polycarbonates are polymers of bisphenol A (BPA), a well-known endocrine disruptor. This study evaluated the release of BPA from polycarbonate crowns that were (1) milled from Temp Premium Flexible (ZPF, Zirkonzahn, Italy) or Tizian Blank Polycarbonate (TBP, Schütz Dental, Germany), or (2) 3D-printed (Makrolon 2805, Covestro, Germany). Commercial prefabricated polycarbonate crowns (3M, USA) and milled poly(methyl methacrylate) (PMMA) crowns (Temp Basic, Zirkonzahn, Italy) were included for comparison. The crowns were stored at 37 °C in artificial saliva (AS) or methanol, which represented the worst-case scenario of BPA release. Extracts were collected after 1 day, 1 week, 1 month and 3 months. BPA concentrations were measured using liquid chromatography-tandem mass spectrometry. The amounts of released BPA were expressed in micrograms per gram of material (μg/g). After 1 day, the highest amounts of BPA were measured from milled polycarbonates, TBP (methanol: 32.2 ± 3.8 μg/g, AS: 7.1 ± 0.9 μg/g) and ZPF (methanol 22.8 ± 7.7 μg/g, AS: 0.3 ± 0.03 μg/g), followed by 3D-printed crowns (methanol: 11.1 ± 2.3 μg/g, AS: 0.1 ± 0.1 μg/g) and prefabricated crowns (methanol: 8.0 ± 1.6 μg/g, AS: 0.07 ± 0.02 μg/g). Between 1 week and 3 months, the average daily release of BPA in methanol and AS decreased below 2 μg/g and 0.6 μg/g, respectively. No BPA was released from PMMA in AS, and the cumulative amount released in methanol was 0.2 ± 0.06 μg/g. In conclusion, polycarbonates could be a relevant source of BPA, but the current tolerable daily intake of BPA (4 μg/kg body weight) should not be exceeded.

A New Specific and Sensitive RT-qPCR Method Based on Splinted 5' Ligation for the Quantitative Detection of RNA Species Shorter than microRNAs

Recently, we discovered a new family of unusually short RNAs mapping to 5.8S ribosomal RNA (rRNA) and which we named dodecaRNAs (doRNAs), according to the number of core nucleotides (12 nt) their members contain. To confirm these small RNA-sequencing (RNA-Seq) data, validate the existence of the two overly abundant doRNAs-the minimal core 12-nt doRNA sequence and its + 1-nt variant bearing a 5' Cytosine, C-doRNA-and streamline their analysis, we developed a new specific and sensitive splinted 5' ligation reverse transcription (RT)-quantitative polymerase chain reaction (qPCR) method. This method is based on a splint-assisted ligation of an adapter to the 5' end of doRNAs, followed by RT-qPCR amplification and quantitation. Our optimized protocol, which may discriminate between doRNA, C-doRNA, mutated and precursor sequences, can accurately detect as low as 240 copies and is quantitatively linear over a range of 7 logs. This method provides a unique tool to expand and facilitate studies exploring the molecular and cellular biology of RNA species shorter than microRNAs.

Relative motion flexion splinting for the rehabilitation of flexor tendon repairs: A systematic review

Introduction

Relative motion splinting has been used successfully in the treatment of extensor tendon repairs and has recently been applied in flexor tendon rehabilitation. The purpose of this systematic review was to identify articles reporting use of relative motion flexion (RMF) splinting following flexor tendon repair and to examine indications for use and clinical outcomes.

Methods

Seven medical databases, four trials registries and three grey literature sources were systematically searched and screened against pre-specified eligibility criteria. Screening, data extraction and quality appraisal were independently performed by two reviewers.

Results

A total of 12 studies were identified, of which three met the review eligibility criteria: one retrospective case series; one cadaveric proof of concept study; and one ongoing prospective case series. The type of splint (including metacarpophalangeal joint position and available movement), exercise programme, and zone of tendon injury varied between studies. Both case series presented acceptable range of movement and grip strength outcomes. The prospective series reported one tendon rupture and two tenolysis procedures; the retrospective series reported no tendon ruptures or secondary surgeries.

Discussion

We found limited evidence supporting the use of RMF splinting in the rehabilitation of zones I-III flexor tendon repairs. Further prospective research with larger patient cohorts is required to assess the clinical outcomes, patient reported outcomes and safety of RMF splinting in comparison to other regimes. Application of the relative motion principles to flexor tendon splinting varied across the included studies, and we suggest an operational definition of relative motion in this context.

Effects of occlusal splint therapy on opposing tooth tissues, filling materials and restorations

Background

Little is known about the effect of the type of splint material, heat‐cured PMMA (HC) or chemical‐cured PMMA (CC) on the wear of opposing tooth surfaces.

Objective

The aim of this in vitro study was to evaluate two‐body wear of dentin, enamel, glass‐ceramic or one of four resin composites when opposing splint materials, namely ProBase HC and CC.

Methods

The two‐body wear of bovine dentine, bovine enamel, glass‐ceramic IPS e.max CAD (EMAX) and four composites (Filtek Z250 [Z250], Clearfil AP‐X [AP‐X], Clearfil Majesty Posterior [CMP], Filtek Supreme XTE [FSE]) opposing three antagonists (HC and CC and stainless steel as control) were evaluated in the ACTA wear machine. In addition, all the surfaces were evaluated with scanning electron microscopy.

Results

The highest average wear was observed in the case of dentin. The lowest average wear was found EMAX. In every case—except for EMAX—the wear rate was higher with HC than with CC (all differences being statistically significant).

Conclusions

The level of wear of enamel, dentin and various resin composites was higher in contact with HC than in CC, the wear of dentin being the highest. In the case of a patient with no or little tooth wear or whose teeth are restored with composite material or glass‐ceramic, the splint HC might be preferred because of its better durability. However, when the splint is in contact with opposing dentin preservation of the dentin, CC might be the best choice.

The non-operative management of bony mallet injuries

Over a 4-year period, 218 mallet fractures in 211 adult patients were treated using a custom-made thermoplastic splint. Clinical results were collected prospectively, including the visual analogue score for pain, the range of motion and extensor lag, and the Patient Evaluation Measure (PEM). The joints were congruent in 168 and subluxed in 50. There were no differences in range of movement, extensor lag or PEM associated with articular subluxation or the size of the articular fragment. Pre-existing joint degeneration did not influence outcome. Non-surgical treatment demonstrates predictably good outcomes regardless of fragment size or subluxation in most patients and should be considered when discussing treatment for patients with bony mallet fractures.Level of evidence: III.

Pressure Algometry Evaluation of Two Occlusal Splint Designs in Bruxism Management-Randomized, Controlled Clinical Trial

The aim of this pilot study was to evaluate the short-term effectiveness of two different occlusal devices and their impact on the pressure pain threshold (PPT) values among patients who reported to the Dental Prosthetics Outpatient Clinic of Pomeranian Medical University (Szczecin, Poland) and who were diagnosed with probable bruxism. Two groups were formed (A and B) to which patients were assigned randomly. Each group used a different occlusal splint for bruxism management. The occlusal appliance by Okeson, or the bimaxillary splint, was used overnight by each patient for 30 days of the study. The PPT was measured twice, at the first visit and after 30 days of using each occlusal device, with Wagner Paintest FPX 25 algometer. Bruxism was diagnosed based on data from the patient's medical history and from the physical examination. Nocturnal Bruxism Criteria according to the International Classification of Sleep Disorders (Third Edition) was used for the patient's evaluation. Results: similar pain factor (PF) reduction was observed in both the examined groups, regardless of the device used; canine guidance and no guidance were similarly effective in terms of increasing pain resilience.

PATIENT-REPORTED OUTCOMES FOR USE OF SILVERSPLINTS IN OSTEOARTHRITIS OF THE HAND

Pain, stiffness and joint deformity can result in significantly reduced hand function in people with osteoarthritis. Characteristic finger deformities in osteoarthritis are swan neck deformity and boutonnière deformity. Several studies have reported that an orthosis decreases pain and increases function during daily activities for patients with arthritis. The aim of this study was to review patient-reported outcomes of current conservative therapeutic management with silver ring splints (silversplints) for patients with osteoarthritis of the hand. There was a 76% improvement in overall daily functioning and a 74% reduction in pain. Several questions concerned daily activities with different types of hand function and with different types of grip and use of fingers. The results show a major improvement in both the more open grip of the hand and activities requiring fine motor skills. The ability to use force with the hand, even when wearing an orthosis, is an important result. Patients who experienced "no problems or minor problems" had significantly increased functioning in several activities of daily living, but the largest improvement in functioning was seen in "household chores" (243%), "opening jars" (150%) and "lifting groceries" (143%). Overall, silversplints appear to serve as a suitable support for the joints in osteoarthritis of the hand, providing pain relief by preventing the joint from moving through its full range of motion. Use of silversplints to treat patients with osteoarthritis of the hand should be considered as a useful, non-surgical method.

Successful minimally invasive intervention in a primary central incisor after root fracture: A case report

Root fractures vary in severity, extent, and location, according to the physical and mechanical aspects of the accident. Root fractures are rare in primary teeth and they affect dentin, cementum, periodontal ligament and the pulp. This paper reports a case of a two-and-a-half-year-old baby who had a root fracture of the upper right primary central incisor (tooth 51) as a consequence of trauma that was managed with minimally invasive intervention. After clinical and radiographic examinations, the presence of tooth mobility, pain, bleeding and a horizontal apical root fracture was diagnosed on tooth 51. The treatment of choice was splinting for 120 days, which can deliver excellent results regardless of the patient's age. The tooth was preserved without needing endodontic intervention until its physiologic exfoliation and normal eruption of its permanent successor. As sequelae to the fractured tooth 51, there was some coronal color alteration and dystrophic calcification of the root canal. This tooth did not develop ankylosis or mobility during the follow-up period. After 57 months of follow-up, repositioning and splinting were appropriate ways to manage this horizontal root fracture in the apical third of this primary tooth. It allowed the tooth to be preserved in the arch with normal function.

Universal Adhesive for Fixed Retainer Bonding: In Vitro Evaluation and Randomized Clinical Trial

This study aims to assess the efficacy of a universal adhesive (Scotchbond Universal, 3M ESPE) (SB) in total-etch mode, compared to a traditional orthodontic primer (Transbond XT Primer, 3M ESPE) (XT Primer), to perform bonding of orthodontic fixed retainers along with the Transbond XT Light Cure Adhesive Paste (3M ESPE). For the in vitro study, a round section wire (Ortosmail Krugg) was bonded using XT Primer for 20 bovine incisors (Group 1) and SB for other 20 (Group 2). Samples were debonded in a universal testing machine applying a tangential force to specimens (crosshead speed of 1 millimeter per minute). Shear bond strength (SBS) and adhesive remnant index (ARI) scores were calculated. For the in vivo study, 100 patients needing upper and lower canine-to-canine fixed retainers after orthodontic treatment were randomly assigned to two groups of 50 participants each, i.e., group 1 (retainer bonding with XT Primer) and group 2 (retainer bonding with SB). Over two years, examinations were carried out monthly, and detachments were registered by considering the teeth and arches affected. In vitro, no statistically significant differences in SBS and ARI scores were demonstrated between the two groups, both showing a mean bond strength of about 12 MPa and major frequency of ARI “2” (>50% remnant adhesive on the enamel). Conversely, a significantly lower failure rate over 2 years was assessed clinically for group 2 in both arches. Independently of the adhesive and arch, incisors reported a significantly higher failure rate than canines. Scotchbond Universal used in total-etch mode could be a valid alternative to the traditional orthodontic Transbond XT Primer.

Digitally programmed (CAD) offset values for prototyped occlusal splints (CAM): assessment of appliance-fitting using surface-based superimposition and deviation analysis

AIM

Limited data are available on the fitting properties of prototyped occlusal appliances. The aim of the present study was to assess the fitting of prototyped splints digitally designed with different offset values and generated with two different biocompatible resins.

MATERIALS AND METHODS

Ten dental digital models were included, and occlusal splints were designed with different offset values (0.0, 0.05, 0.10, 0.15, 0.20, and 0.25 mm). Each splint was 3D printed using two different biocompatible resins, and the gap between the splint and the teeth was recorded by placing impression material. A specific 3D technology was used to assess the gap volume between the splint and the teeth and to calculate the Euclidean distance between the surface points of two digital models, with and without the gap volume.

RESULTS

The splints with a 0.20-mm offset value showed smaller gap volume and deviation analysis values compared with those with offset values of 0.15 and 0.25 mm (P < 0.05). These results were consistent with both types of biocompatible resins used. For each offset value tested, the gap volume and deviation value analysis did not significantly differ between the splints printed with the two different resins.

CONCLUSION

According to the present findings, the 0.20-mm offset value would be the best choice when digitally designing occlusal appliances.

Peripheral intravenous cannulae in neonates: To splint or not?

OBJECTIVE

To determine the effect of splint on the dwell time of peripheral intravenous cannula in neonates.

SETTING

Level II Neonatal Intensive Care Unit (NICU).

PATIENTS

Consecutive babies with presumed need of peripheral intravenous access of at least 24 h.

METHODS

Enrolled subjects were randomized to "splint" or "splint-less" group. Insertion site was cleaned with Isopropyl alcohol and 2% Chlorhexidine and peripheral intravenous catheter was inserted under strict asepsis. Insertion sites was examined regularly for occurrence of complication which necessitated removal of the catheter.

RESULTS

Out of 159 neonates, 80 were allotted to splint group and the rest to splint-less group. Mean dwell time of intravenous line in splint group was 27.68 ± 13.03 h which was significantly less than in splint-less group (32.87 ± 15.79 h, mean difference: 5.11 h, p value: 0.03). Subgroup analysis in preterms showed mean dwell time of 28.54 ± 14.86 h in splint group which was less than that of splint-less group (35.10 ± 16.24 h) (p value: 0.03). No such difference was noted in the term neonates. Subgroup analysis for catheters put across joints does not show difference in mean dwell times between splint and splint-less groups. Multivariate regression analysis did not identify any variable which independently affected the outcome.

CONCLUSION

Use of splint does not prolong the dwell time of the catheter and is probably harmful in some neonates.

Assessment of Splinting Quality: A Prospective Study Comparing Different Practitioners

BACKGROUND

Splinting is routinely performed in the emergency department (ED), and follow-up visits of improperly placed splints are commonplace in orthopaedic clinics. As open reduction and internal fixation (ORIF) of fractures has become the preferred treatment for many injuries, orthopaedic surgeons and emergency physicians have received less instruction on splinting technique. Limited literature exists regarding error/complication rates of splint application. The purpose of this study is to determine: (1) Is there a difference in splinting complication rates between orthopaedic and non-orthopaedic services, and low versus high volume emergency room and urgent care centers? (2) What are the most common technical errors and complications in splint application?

METHODS

Patients presenting to orthopaedic clinic with any extremity splint were enrolled in this IRB approved prospective study. Splint characteristics collected included: type of provider placing the splint, duration of wear, type of splint, and material used (i.e. plaster or fiberglass). Errors included inappropriate length, circumferential placement, and direct contact between the ACE bandage and the skin; while complications included swelling, blistering, ulceration, heat injury, and other issues on a case-by-case basis.

RESULTS

203 patients were enrolled in this study. 98 (48%) were splinted by the Orthopaedics service, 69 (34%) were splinted in the trauma hospital ED, and 36 (18%) were treated at an outside hospital. 123/203 (61%) had an error/ complication related to the splint. Error/complication rates for orthopaedics, the trauma hospital ED, and outside hospitals were 46% (45/98), 65% (45/69), and 92% (33/36) respectively. The most common errors were inappropriate length, present in 58/203 (29%) patients, and direct contact between the ACE bandage and skin, present in 50/203 (25%) patients.

CONCLUSION

The appropriateness and complication rates of splints applied in the ED differ based on the type of provider and the institution. Outside hospitals were found to have the highest complication rates, while the lowest rates were associated with splints placed by Orthopaedics. These findings support the importance of education of proper splinting technique in non-trauma hospitals.Level of Evidence: III.

The effect of orthoses on the kinematics of the trapeziometacarpal, scaphotrapeziotrapezoidal, and radioscaphoid joints

The in vivo effect of four different types of thumb and thumb-wrist orthoses on the three-dimensional kinematics of the trapeziometacarpal (TMC), scaphotrapeziotrapezoidal (STT) and radioscaphoid joints was quantified using computed tomography (CT). Eighteen healthy female volunteers were recruited. The dominant hand of each subject was scanned in four thumb and wrist positions, each in three conditions: without orthosis, with a thumb orthosis (Push Ortho and immediate fitting, IMF) and with a thumb-wrist orthosis (Ligaflex Manu and IMF). CT images were analyzed and rotations relative to the more proximal bone were expressed in a joint-specific coordinate system. Without orthosis, the largest STT rotations were observed during radioulnar deviation of the wrist and the STT range of motion (ROM) was significantly lower during wrist flexion-extension. All tested orthoses caused a significant reduction of the ROM at each joint compared to free motion. Significant differences in movement reduction were observed between prefabricated and IMF orthoses.The IMF thumb-wrist outperformed the Ligaflex Manu in terms of immobilization of the radioscaphoid joint. In addition, the IMF thumb orthosis immobilized the TMC joint significantly better during thumb abduction and adduction than the Push Ortho. We found that different types of thumb and thumb-wrist orthotics are effective in reducing joint mobility. While this reduction tends to be higher using IMF compared to prefabricated orthoses, this effect is only significant for the radioscaphoid and TMC joint. The finding that thumb movements do not induce large STT rotations suggests that the thumb does not need to be immobilized in case of isolated STT osteoarthritis.

[Combined therapy with elastic bands and splints in patients with masticatory muscles hypertension]

Was to investigate the effectiveness of combined treatment with elastic bands and splints in patients with masticatory muscle hypertension. 103 patients (37 men and 66 women) aged from 21 to 65 years were examined. The diagnosis was made based on clinical and instrumental (electromyography) methods. Pain intensity was determined using a visual-analog scale (VAS). Elimination of masticatory muscle hypertension in patients of the first group (51 people) was carried out using only splints while patients of the second group (52 people) had a combined therapy with elastic bands and splints. In the second group of patients reliable reducing of pain intensity was observed by day 14 from the start of therapy (4.54±0.5 points), while in the first group of patients it was discovered only by day 21 (5.08±0.6 points). Reliable changing of the bioelectrical activity of masticatory muscles in the second group of patients was observed by the beginning of second week from the start of preliminary therapy, while in the first group of patients it was discovered only by the third week. Thus, the proposed method of masticatory muscles hypertension treatment using elastic bands and splints has features, favorably distinguish it from the other methods of the therapy, because it provides sparing functioning condition for masticatory muscles.

A comparison of prefabricated and custom made resting hand splints for individuals with cervical spinal cord injury: A randomized controlled trial

OBJECTIVE

To compare prefabricated and custom resting hand splints and establish the feasibility of splinting research for larger scale trials.

DESIGN

A Randomized controlled pilot study where the randomization unit was each hand, rather than each individual.

SETTING

Thirty-two-bed spinal cord injury and multi-trauma rehabilitation unit in an urban academic rehabilitation center.

SUBJECTS

Thirty-six hands from 19 individuals with cervical spinal cord injury were enrolled during their acute rehabilitation stay.

INTERVENTIONS

Each eligible hand was randomized to receive a custom or prefabricated resting hand splint for night use.

MAIN MEASURES

The Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) was completed at both admission and discharge, and a structured interview was completed at discharge.

RESULTS

No difference existed in GRASSP outcomes or user preference between custom and prefabricated resting hand splints. Mann-Whitney tests indicated that there was no significant difference in qualitative prehension scores (U = 141, P = 0.522) nor quantitative prehension scores (U = 135, P = 0.382) between groups. Adherence to the splinting program was high (18 out of 19 participants), and no adverse effects occurred. Four themes emerged from the participant comments: the participants felt splints were helpful in their recovery; they found it challenging to direct their caregivers to help with the splints; they needed to take ownership for managing their splints; and they wished they received more education on splint rationale.

CONCLUSION

There was no obvious difference in outcome or user preference between prefabricated and custom resting hand splints.

The effects of hand splinting in patients with early-stage thumb carpometacarpal joint osteoarthritis: a randomized, controlled study

Background/aim

Evidence for the effectiveness of splinting in thumb carpometacarpal osteoarthritis is limited. We aimed to evaluate the effects of a prefabricated carpometacarpal metacarpophalangeal immobilization splint on pain, hand function, and hand strength in patients with early-stage thumb carpometacarpal osteoarthritis.

Materials and methods

Sixty-three hands with stage 1 or 2 thumb carpometacarpal osteoarthritis were enrolled in the study. The nonsplint group received oral information about how to accommodate daily activities. The splint group was given a prefabricated carpometacarpal metacarpophalangeal immobilization splint for 6 weeks. Pain was evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN). Hand functions were evaluated using the AUSCAN and the Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) questionnaire. Grip and pinch strengths were measured using a hydraulic dynamometer and a hydraulic pinch gauge.

Results

The AUSCAN pain, stiffness, function, total scores, and Q-DASH scores were significantly decreased in the splint group compared to the nonsplint group. Significant increments in grip and pinch strengths were detected in the splint group compared to the nonsplint group.

Conclusion

The prefabricated carpometacarpal metacarpophalangeal immobilization splint is effective in improving pain, hand function, and hand strength in patients with thumb carpometacarpal osteoarthritis.

Surgical Extrusion of Anterior Teeth with Intrusion Traumatic Injury: A Report of two Cases

Intrusion is the most severe luxation injury type, which results in both soft and hard tissue damage. In severe intrusions, the crown must be re-positioned in the arch to avoid periapical pathology and marginal bone loss. There is minimal information about the effect of treatment delay on pulpal and periodontal healing in intrusion trauma. The present paper reports on two cases of severe intrusive luxation applied late at different times treated with surgical extrusion. The first patient, an 11-year-old female, referred to Tokat GOP pediatric dentistry clinic three days after the intrusion tooth 21. The second patient, a 13-year-old male, referred to our clinic fifteen days after a traffic accident. The intruded teeth were positioned surgically and splinted. Surgical extrusion should be preferred as soon as possible to initiate root canal treatment in teeth, the crown of which is fully embedded in the alveolar bone.

Use of a modified mandibular splint to reduce nocturnal symptoms in persons with post-traumatic stress disorder

OBJECTIVE

Based on a series of clinical observations that a thicker mandibular splint than that commonly used to treat bruxism and related craniomandibular myofascial pain reduced post-traumatic stress disorder (PTSD) nocturnal symptomatology (sleep disruptions, headaches, and nightmares), this study of 100 PTSD participants was undertaken to systematically establish 'proof of concept' of the therapeutic effectiveness of this modified splinting procedure.

METHODS

Following the fabrication of splints thicker than those conventionally used, the effectiveness of this new procedure used by dentists was determined by comparing the self-reported frequency and intensity/severity of PTSD symptomatology during a seven-night pretreatment baseline period without the splint with a second seven-night period in which the modified splint was inserted. The scoring for the three dependent measures (sleep disruptions, headaches, and nightmares) was based on the frequencies on a scale from 0-7 multiplied by the intensity/severity on a scale of 1-10.

RESULTS

Compared with the pre-splint baseline period, the insertion of the thickened splint resulted in a highly significant reduction of sleep disruption, nocturnal headaches, and nightmares. A second seven-night control period without the splint was followed by a second seven-night period with the splint, reproducing the effectiveness of the first splinting period.

CONCLUSION

The results of this study provide the first systematic, documented proof of concept of the effectiveness of a modified splinting procedure in reducing key nocturnal symptoms in PTSD patients.

Clinical Accuracy of 3D-Planned Maxillary Positioning Using CAD/CAM-Generated Splints in Combination With Temporary Mandibular Fixation in Bimaxillary Orthognathic Surgery

Study Design

The aim of this study was to evaluate the accuracy of 3-dimensional (3D)-planned maxillary positioning by using computer-assisted design (CAD)/computer-assisted manufacturing (CAM) splints combined with temporary mandibular fixation in bimaxillary orthognathic surgery. In orthognathic surgery, customized splints work sufficiently well to transfer preoperative planning into the operation site for transverse und sagittal positioning of the maxilla. The vertical positioning is more difficult due to the non-fixed mandibular reference. Therefore, the combined use of CAD/CAM splints and temporary mandibular fixation to the zygomatic region was applied for transferring the 3D-planned maxillary position into the operation site from 2012 until 2015 in our hospital.

Objective

In addition to the general accuracy, the precision should therefore be checked especially in the vertical plane compared to axial and sagittal plane.

Methods

In this retrospective study, we calculated the deviation of 5 occlusal landmarks of the maxilla in 35 consecutive patients by fusing preoperative 3D planning images and postoperative computed tomography scans after bimaxillary surgery.

Results

The overall median deviation of maxillary positioning between plan and surgical result was 0.99 mm. The accuracy of left-right positioning was median 0.96 mm. Anterior-posterior positioning of the maxilla showed a median accuracy of 0.94 mm. Just slightly higher values were determined for the upward-downward positioning (median 1.06 mm).

Conclusions

This demonstrates the predictability of maxillary positioning by using CAD/CAM splints in combination with temporary mandibular fixation in all 3 axes.

Splinting versus extension-block pinning of bony mallet finger: a randomized clinical trial

Surgical treatment of bony mallet fingers is frequently recommended, but the evidence is sparse. This randomized clinical trial aimed to compare nonoperative splinting versus extension-block pinning of bony mallet fingers with involvement of more than one-third of the joint surface but without primary joint subluxation. Thirty-two patients were randomized and 28 fulfilled the protocol. At 6 months follow-up, there were no significant differences in active extension lag in the distal interphalangeal joint (the primary outcome) or in patient-reported function and pain scores. Flexion and active range of motion in the distal interphalangeal joint and finger-to-palm distance were better in the splinting group, but three patients developed secondary subluxation. We conclude from this study, that splinting these injuries is safe and efficient in restoring joint motion, but splinting does not sufficiently prevent secondary subluxation of the joint. Radiographic follow-up during splinting appears to be necessary. Level of evidence: I.

Fear of the Relapse: Effect of Composite Type on Adhesion Efficacy of Upper and Lower Orthodontic Fixed Retainers: In Vitro Investigation and Randomized Clinical Trial

The aim of this laboratory and clinical study is to determine the reliability of the flowable nanocomposite Filtek Supreme XTE (FL) for the adhesion of orthodontic retainers, compared to highly filled orthodontic resin Transbond XT (XT). Portions of a round section multistranded wire (Ortosmail Krugg) were bonded to 40 bovine incisors with Scotchbond Universal in total-etch modality. For group one (XT, 20 samples), the orthodontic resin was used, whereas in group two (FL, 20 samples), the flowable one. Specimens were placed into a universal testing machine which applied a shear force on retainers with a crosshead speed of one/minute. Shear bond strength (SBS) and adhesive remnant index (ARI) scores were calculated. In the clinical trial, 100 patients requiring a canine-to-canine palatal and lingual retainer were randomly divided into two groups, according to the resin used for bonding procedure: the orthodontic in group one (XT, 50 participants) and the flowable in group two (FL, 50 participants). Monthly visits were carried out over a 24-month follow up to assess any detachment occurring on teeth of both arches. All data were submitted to statistical analysis. In vitro, FL reported a significant lower mean SBS, whereas no significant differences in ARI were reported between the two groups which both showed a major frequency of scores “1” and “2”. At the end of the 24-month follow up, FL reported significantly higher failure rates in both arches besides a significantly lower survival rate starting from the sixth month after retainers bonding. According to the results assessed in vitro and clinically, XT would be preferable to FL when performing retainers bonding procedure.

The Use of a Novel CAD-CAM Splint to Simplify Open Reduction and Internal Fixation of Mandibular Angle Fracture: A Technical Note

Mandibular angle fractures are frequently encountered as they constitute an area of weakness. Complications after open reduction and internal fixation (ORIF) of angle fractures commonly arise due to improper reduction and fixation methods that fail to counteract the dynamic muscle forces present in this region. Conventional reduction methods such as digital manipulation, intermaxillary fixation, towel clip traction, and wiring are associated with various limitations. This technical note highlights the fabrication and use of a computer-aided designing/computer-aided manufacturing-generated splint for ORIF of a superiorly displaced mandibular angle fracture. The splint consisted of 2 components: (1) a distal tooth-borne component to guide the teeth into maximum intercuspation and (2) a proximal bone-borne component to reduce the angle fracture. This composite splint facilitates simultaneous restoration of occlusion as well as reduction of mandibular angle fractures. The advantages of this technique include the following: (1) easy fabrication of splint, (2) easy and precise anatomical reduction of angle fracture, and (3) less operative time.