Comparison on the Effectiveness and Safety of Transseptal Suturing Versus Intranasal Splints After Septoplasty: A Systematic Review and Meta-analysis

BACKGROUND

The application of transseptal suturing as an alternative to intranasal splints in preventing postoperative complications, such as synechia, and maintaining nasal septal stability following Septoplasty, remains controversial. This meta-analysis aims to systematically compare the effectiveness and safety of transseptal suturing with intranasal splints after Septoplasty.

METHODS

A comprehensive systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The review included randomized clinical trials (RCTs) identified through a database search in July 2023, comparing postoperative complications following Septoplasty with the transseptal suturing technique versus intranasal splints.

RESULTS

Eight published RCTs involving 570 participants were included in the meta-analysis. The analysis revealed no significant difference between the transseptal suturing and intranasal splint techniques following Septoplasty in postoperative complications, including postoperative hemorrhage, synechia, septal hematoma, septal perforation, local infection, crusting, and residual septal deviation.

CONCLUSIONS

Transseptal suturing can be applied following Septoplasty as an alternative to intranasal splints without increasing the rate of postoperative complications.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Digital manufacturing techniques and the in vitro biocompatibility of acrylic-based occlusal device materials

OBJECTIVES

Material chemistry and workflow variables associated with the fabrication of dental devices may affect the biocompatibility of the dental devices. The purpose of this study was to compare digital and conventional workflow procedures in the manufacturing of acrylic-based occlusal devices by assessing the cytotoxic potential of leakage products.

METHODS

Specimens were manufactured by 3D printing (stereolithography and digital light processing), milling, and autopolymerization. Print specimens were also subjected to different post-curing methods. To assess biocompatibility, a human tongue epithelial cell line was exposed to material-based extracts. Cell viability was measured by MTT assay while Western blot assessed the expression level of selected cytoprotective proteins.

RESULTS

Extracts from the Splint 2.0 material printed with DLP technology and post-cured with the Asiga Flash showed the clearest loss of cell viability. The milled and autopolymerized materials also showed a significant reduction in cell viability. However, by storing the autopolymerized material in dH2O for 12 h, no significant viability loss was observed. Increased levels of cytoprotective proteins were seen in cells exposed to extracts from the print materials and the autopolymerized material. Similarly to the effect on viability loss, storing the autopolymerized material in dH2O for 12 h reduced this effect.

CONCLUSIONS/CLINICAL RELEVANCE

Based on the biocompatibility assessments, clinical outcomes of acrylic-based occlusal device materials may be affected by the choice of manufacturing technique and workflow procedures.

Wear resistance and flexural properties of low force SLA- and DLP-printed splint materials in different printing orientations: An in vitro study

OBJECTIVES

To investigate the influence of material and printing orientation on wear resistance and flexural properties of one low force SLA- and two DLP-printed splint materials and to compare these 3D-printed splints to a subtractively manufactured splint material.

METHODS

Two DLP-printed (V-Print splint, LuxaPrint Ortho Plus) and one low force SLA-printed (Dental LT Clear) material, where specimens were printed in three printing orientations (0°, 45°, 90°), were investigated. In addition, one milled splint material (Zirlux Splint Transparent) was examined. A total of 160 specimens were produced for both test series. The two-body wear test was performed in a chewing simulator (80'000 cycles at 50 N with 5-55 °C thermocycling). Steatite balls were used as antagonists. The wear pattern was analyzed with a 3D digital microscope in terms of maximum vertical intrusion depth (mm) and total volume loss (mm³). The flexural properties were investigated by three-point bending in accordance with ISO 20795-1: 2013 (denture base polymers). The flexural strength (MPa) and the flexural modulus (MPa) were measured. Two-way ANOVA was performed to investigate the effects of the two independent variables material and printing orientation for the three 3D-printed materials. The comparison of the printing orientations within one material was carried out with one-way ANOVA with post-hoc Tukey tests.

RESULTS

Two-way ANOVA revealed that wear and flexural properties are highly dependent on the 3D-printed material (p < 0.001). Across groups, a significant effect was observed for wear depth (p = 0.031) and wear volume (p = 0.044) with regard to printing orientation but this was not found for flexural strength (p = 0.080) and flexural modulus (p = 0.136). One-way ANOVA showed that both DLP-printed groups showed no significant differences within the printing orientations in terms of wear and flexural properties. Dental LT Clear showed that 90° oriented specimens had higher flexural strength than 0° oriented ones (p < 0.001) and 45° oriented specimens also showed higher values than 0° ones (p = 0.038). No significant differences were observed within the printing orientations for flexural modulus and wear behaviour within this group. T-tests showed that the milled splints exhibited statistically higher wear resistance and flexural properties compared to all three 3D-printed splint materials (p < 0.001) and that highly significant differences were found between the 3D-printed splint materials for both test series.

CONCLUSION

Within the limitations of this in vitro study, it can be stated that wear behaviour and flexural properties are highly dependent on the 3D-printed material itself. Currently, milled splints exhibit higher wear resistance and flexural properties compared to 3D-printed splint materials. The printing orientation has a minor influence on the properties investigated. Nevertheless, two-way ANOVA also showed a significant influence of printing orientation in the wear test across groups and one-way ANOVA detected significant effects for SLA material in terms of flexural strength, with printing in 90° showing the highest flexural strength. Therefore, anisotropy was found in SLA material, but it can be limited with the employed printing parameters. Both DLP-printed materials showed no significant difference within the printing orientation.

A 3D Finite Element Analysis of biomechanical effects on teeth and bone during true intrusion of posteriors using miniscrews

OBJECTIVE

The primary objective of this study was to investigate the biomechanical effects and stresses on bone, PDL, cementum and displacement along X-,Y- and Z-axis during true intrusion of molars using mini-implants with finite element analysis; the secondary objective of the study was to find out the best method for posterior intrusion in clinical practice.

MATERIAL AND METHODS

A 3D finite element method was used to simulate true molar intrusion using sliding mechanics. Two groups were made, with mini-implants placed on buccal side and palatal side with a cap splint for MODEL1, and a single mini-implant placed buccally with transpalatal arch (TPA) for MODEL2. The material characteristics which include the Young's modulus and Poison's ratio were assigned. von Mises stress, principal stress on PDL and alveolar bone, displacements in all the 3 planes were determined.

RESULTS

Bone stress patterns showed compressive stresses on the buccal aspect and tensile stresses on the palatal aspect for both MODELS. Stresses in the PDL and cementum were mainly concentrated in the apex region, with a more uniform distribution of stresses for MODEL 1. Tooth displacement showed true intrusion for both MODELS, i.e. the Z axis, and a more controlled buccal tipping for MODEL 1.

CONCLUSION

Of the modalities compared, the best controlled tooth movements for posterior intrusion in the treatment of open bite were obtained with mini-implants placed with a cap splint (MODEL 1).

Neuromodulation of the median nerve in carpal tunnel syndrome, a single-blind, randomized controlled study

Background

This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS).

Methods

After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity.

Results

Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t -test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t -test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group.

Conclusions

NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS.

Effectiveness of high-intensity laser application combined with splinting and therapeutic exercise in subacute de Quervain's tenosynovitis: A pilot study

The purpose of this study is to determine the additional effect of high-intensity laser therapy (HILT) when combined with therapeutic exercise and splinting in the treatment of patients diagnosed with de Quervain's tenosynovitis. Nineteen patients diagnosed with de Quervain's tenosynovitis were randomly divided into two groups: the HILT group and the sham HILT group. A total of 9 HILT or sham HILT sessions were administered, with 3 sessions per week for 3 consecutive weeks. Both groups received the thumb spica splint and therapeutic exercise. A comparison was conducted between the two groups, as well as pre- and post-treatment, focusing on the following outcomes: Visual Analog Scale (VAS) for pain, hand grip strength, and Thai version of Patient-Rated Wrist and Hand Evaluation (PRWHE-Thai) as a disability score. No significant differences were found between the HILT group and the sham group across all evaluated outcomes. However, when examining changes within each group over time, both the HILT and sham groups showed significant reductions in pain and improvements in disability score at the follow-up assessments compared to baseline. On the other hand, no statistically significant differences were observed in grip strength outcomes at any of the measured time points. The combination of HILT with a splint and exercise demonstrates effectiveness as a method for pain management and functional improvement in patients with subacute de Quervain's tenosynovitis. It is important to note that HILT does not offer any additional advantages when compared to the combined use of a splint and exercise.

Evaluation of flexible three-dimensionally printed occlusal splint materials: An in vitro study

OBJECTIVE

To evaluate and compare the mechanical properties, water sorption, water solubility, and degree of double bond conversion of three different commercially available three-dimensional (3D) printing resins used for the fabrication of flexible occlusal splints.

METHODS

A digital printer was used to generate specimens from the evaluated splint materials (KeySplint Soft, IMPRIMO LC Splint flex, and V-Print splint comfort). The specimens were equally divided and tested either dry or after water storage at 37 °C for 30 days. A three-point bending test was used to assess flexural strength, elastic modulus, and fracture toughness. A two-body wear test was performed using a dual-axis chewing simulator. Water sorption and water solubility were measured after 30 days. The degree of double bond conversion was determined by FTIR-spectrometry. All data for the evaluated properties were collected and statistically analyzed.

RESULTS

Both material and storage conditions had a significant effect on the flexural strength (P < 0.001), elastic modulus (P < 0.001), fracture toughness (P < 0.001), and wear (P < 0.001). The highest water sorption was noticed with IMPRIMO LC Splint flex (1.9 ± 0.0 %), while V-Print splint comfort displayed the lowest water solubility (0.2 ± 0.0 %). For the degree of conversion, it was statistically non-significant among the different materials (P = 0.087).

SIGNIFICANCE

Different flexible 3D-printed splints available in the market displayed variations in the evaluated properties and clinicians should consider these differences when choosing occlusal device materials. Among the tested flexible splint materials, KeySplint Soft had the greatest flexural strength, elastic modulus, fracture toughness, wear resistance, and degree of conversion. It also showed the lowest water sorption.

Evaluation of the Effect of Antibiotics and Splints on the Result of Septal Mucosal Culture After Septoplasty

Purpose

Post operation infection after septoplasty is very rare, possibly due to excessive nasal blood supply. Most otorhinolaryngologists recommend antibiotics after septoplasty; however, controversial results were available. Therefore, this study was designed to investigate the effect of antibiotics after septoplasty.

Methods

In this study, 90 patients who were candidates for septoplasty were entered the study and divided into three groups. The first group did not receive any oral antibiotics after septoplasty. The second group took 500 mg of oral cephalexin. The third group, for whom splints were used, also received cephalexin. The culture of the nasal mucosa was prepared before and two weeks after surgery and compared between groups. Then, the amount and types of mucosa microorganisms were reported. Data were analyzed using SPSS16.

Results

The growth significantly increased in the first group (p = 0.051) and reduced in the second group (p < 0.001). While a decreased growth rate was observed in the third group, it was not statistically significant (p = 0.12).

Conclusion

The present study highlighted the beneficial role of prophylactic antibiotics administration in patients without splints on bacterial growth, while it had no effect in patients with splints.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03665-w.

Effects of offset design on the accuracy of bracket placement with a guided bonding device

BACKGROUND

This study aimed to evaluate the effects of offset design on the accuracy of bracket placement for computer-aided design and computer-aided manufacturing (CAD/CAM)-guided bonding devices (GBDs) in vitro.

METHODS

Eight dental models were selected. Seven types of GBDs were designed and three-dimensionally (3D) printed for each model, including one without any offset and the other six with translation offsets (TF) and expansion offsets (EF) of 0.05, 0.10, and 0.15 mm, respectively. After the brackets were bonded on the models using the different GBDs in vitro, linear and angular deviations of the bracket positions were evaluated.

RESULTS

In total, 56 GBDs were printed, and 784 brackets were bonded using the GBDs. No misfit between the dentitions and the devices was found during the bonding process. With increasing offset, more brackets were gingivally positioned with the frequencies ranging from 61.61 to 76.79% for the TF groups and from 58.93 to 78.57% for the EF groups. The vertical deviations of the brackets increased from 0.100 to 0.168 mm and from 0.117 to 0.150 mm in the TF and the EF group, respectively, as offset increased. No statistically significant difference was found in the vertical deviation between most of the TF and EF groups with the same offset value (p > 0.05). With respect to angulation, the mean absolute deviations were 0.881, 1.083, and 1.029° in the 0.05-mm, 0.10-mm, and 0.15-mm EF groups, respectively, which were greater than those in the corresponding TF groups (0.799, 0.847, and 0.806°). Similarly, with increasing offset, the mean absolute deviations for rotation in the EF groups (0.847, 0.998, and 1.138°) were greater than those in the TF groups (0.853, 0.946, and 0.896°). Compared with the 0.15-mm TF group, greater angulations (p < 0.05) and rotations (p < 0.01) were found in the 0.15-mm EF group.

CONCLUSIONS

Offset designs influenced the precision of vertical bracket placement with GBDs. Due to the smaller deviations in angulation and rotation of bracket placement, TF is preferred over EF for GBDs. Moreover, the differences between TF and EF also need to be considered in the design of other dental CAD/CAM devices.

Effect of joint immobilization using extension splint immediately after total knee arthroplasty on post-operative knee function and pain: a randomized clinical trial

PURPOSE

Investigate the effect of semirigid extension bracing after total knee arthroplasty (TKA) on articular pain and function.

METHODS

The present randomized clinical trial included 72 patients undergoing unilateral primary TKA. Patients in the case group received eight days of post-operative semirigid extension-locked knee bracing, whereas controls did not. The outcomes assessed preoperatively and on the first, ninth, 30th day, and one year post-operatively included the knee society score (KSS), functional KSS (FKSS), VAS pain score, amount of postoperative opiate painkiller usage (tablet oxycodone 5mg), and knee ROM.

RESULTS

The case group had a significantly lower flexion ROM on postoperative day nine compared to the control group (95.3° vs. 100.8°, p=0.03), while it became significantly higher 1 month (114.1° vs. 104.7°, p=0.03) and one year post-operative (128.0° vs. 120.5°, p=0.002). Also, FKSS was significantly higher in the case group than in the controls in the one month post-operative assessment (37.0 vs. 32.6, p=0.009) but not in the one year post-operative assessment. The case group patients had a significantly lower pain than the controls on days one (5.8 vs. 7.2, p=0.02) and nine post-operative (4.1 vs. 5.2, p=0.048), but not at later assessments. The amount of one month post-operative opium (oxycodone) consumption was significantly lower in the brace group (12.4 vs. 14.1 tablets, p=0.03). The KSS were not significantly different between the groups after the surgery.

CONCLUSION

Extension-locked splinting immediately after TKA is a noninvasive, non-pharmacological, and inexpensive intervention with possible promising effects on knee ROM, short-term functional improvement, and acute post-operative pain management.

Securing peripheral intravenous catheters in babies without applying adhesive dressings to the skin: a proof-of-concept study

BACKGROUND

Most babies admitted to a Neonatal Intensive Care Unit (NICU) require a peripheral intravenous catheter (PIVC). PIVCs are secured using splints and adhesive dressings applied to the skin. Removing the dressings causes skin injury, pain, and risks infection. We designed the Pēpi Splint, which supports PIVCs without the application of adhesive dressings to the skin. We sought to determine the effectiveness and acceptability of the Pēpi Splint using a proof-of-concept design.

METHODS

Eligible babies were > 1000 g and > 30 weeks' corrected gestation admitted to Wellington Regional NICU and who required a PIVC. All babies received the same care as those not in the study, with the addition of the Pēpi Splint. Primary outcomes were the proportion of babies in which the Pēpi Splint secured the PIVC for the required time and proportion of babies who experience an adverse event. Secondary outcomes were the acceptability of the Pēpi Splint as reported by the parents.

RESULTS

Thirty-eight babies, median (range) birth weight 2625 g (396-4970) and gestation 37wk (22-41). When the Pēpi was applied the postnatal weight was 2969 g (1145 - 4970) and gestation 37wk (29 - 41). The Pēpi Splint held the PIVC secure for 34/38 babies (89%), for a duration of 37 h (6 to 97). There were no adverse events. Of the four babies reported to have unsecure PIVCs, two were due to the securement two were displaced during feeding. Fifty-eight parents responded to a questionnaire (32 mothers, 26 fathers). Of these parents 52 (90%) would participate again and 52 (90%) would recommend participating to others. Overall, clinicians reported the Pēpi Splint was easy to use 33/38 (87%).

CONCLUSION

The Pēpi Splint safely secures PIVCs without adhesive dressings being applied to the skin and is acceptable to both parents and clinicians. Our findings provide support for a larger multicentred randomised controlled trial.

TRIAL REGISTRATION

Registered with the Australian and New Zealand Clinical Trials Registry Reference ACTRN12620001335987 .

Effects of storage and toothbrush simulation on color, gloss, and roughness of CAD/CAM, hand-cast, thermoforming, and 3D-printed splint materials

Objectives

The aim was to investigate color, gloss, or roughness of splint materials after storage in liquids and toothbrush simulation.

Materials and methods

A total of 58 × 8 (n = 10 per material and group) specimens were fabricated (hand-cast, thermoforming, CAD/CAM-milled, 3D-printed materials); stored in air, water, coffee, red wine, and cleaning tablets; and investigated after fabrication, 24 h, two-, and four-week storage or toothbrushing. Color values (L*, a*, b*; ISO 11664–4:2008; CM–3500d, Konica-Minolta), gloss (ISO 2813:2014), and roughness values were determined (3D laser-scanning-microscope, KJ 3D, Keyence) before and after simulation or storage. Statistics: Levene-test, one-way ANOVA, Bonferroni post hoc test, between-subjects effects, Pearson correlation (α = 0.05).

Results

Color, gloss, and roughness altered due to contact with staining solutions/toothbrush simulation. Highest impact on color, gloss, and roughness presented the material followed by storage time (ΔE material (η2 = 0.239/p < 0.001), storage time (η2 = 0.179/p < 0.001); gloss (η2 = 0.751/p < 0.001) (η2 = 0.401/p < 0.001); Ra/Rz (η2 ≥ 0.801/p < 0.001) (η2 ≥ 0.416/p < 0.001)). Correlations were found between Rz and Ra (Pearson 0.887/p ≤ 0.001) or Rz and ΔE (0.517/p ≤ 0.001) or Ra and ΔE (0.460/p ≤ 0.001).

Conclusions

Storage and toothbrushing were accompanied by a change in color, gloss, and roughness. Almost all materials showed visible discoloration after 4 weeks of storage. Gloss values decreased as storage time increased. The initial roughness and polishability were better with harder materials.

Clinical relevance.

Milled and 3D printed splints show good color, gloss, and roughness resistance after 4-week storage or toothbrush application.

Below- or above-elbow immobilization in conservative treatment of distal radius fractures: a systematic review and meta-analysis

INTRODUCTION

There is no consensus regarding the range of immobilization in the conservative treatment of distal radius fractures (DRFs). Therefore, this systematic review and meta-analysis aimed to compare the clinical outcome of patients with DRFs treated conservatively with below- or above-elbow immobilization.

MATERIALS AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, two independent reviewers searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and World Health Organization International Clinical Trials Registry Platform in April 2020; a subsequent update search was conducted in April 2021. We identified all randomised controlled trials comparing two immobilization methods in DRFs. The primary outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) or QuickDASH questionnaire scores in the short- and long-term (≤ and >six weeks, respectively) follow-up as well as the treatment failure rate. The secondary outcome measures were radiographic outcome, patient-rated wrist evaluation (PRWE) score, pain score and adverse events. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2. We used the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence.

RESULTS

The initial search revealed 1,775 records, and ten studies with 909 participants in total were included. There was no significant difference in DASH score in the short-term follow-up (4.99 lower, 95% confidence interval (CI): 10.45 lower to 0.46 higher; very low certainty) and treatment failure (risk ratio: 0.91, 95% CI: 0.59 to 1.40; low certainty). A clinically irrelevant but significant mean difference (0.83 lower, 95%CI: 1.64 lower to 0.03 lower; low certainty) was found in the DASH score in favour of below-elbow immobilization in the long-term follow-up. The overall risk of bias in DASH scores was high based on the measurement bias. Furthermore, there was no significant difference in secondary outcome measures.

CONCLUSION

This meta-analysis did not demonstrate clinically meaningful difference between below- and above-elbow immobilization in terms of DASH score both in the short- and long-term follow-ups. However, overall certainty of evidence was considered very low, based on the very serious risk of bias, inconsistency and imprecision. Hence, there is a need for further higher quality research.

TRIAL REGISTRATION NUMBER

UMIN000040134 (4/14/2020).

Characterization of occlusal splint materials: CAD-CAM versus conventional resins

AIM

The aim of this in vitro study was to assess the mechanical properties of five commercially available subtractive computer-aided design and computer-aided manufacturing (CAD-CAM) milled splint materials, as well as to compare them with conventional heat-polymerized and autopolymerizing resins used in the construction of conventional splints.

MATERIAL AND METHODS

Five CAD-CAM milled (ProArt CAD Splint, Therapon Transpa, Temp Premium Flexible Transpa, Cast, and Aqua), one autopolymerizing (Palapress), and one heat-polymerized (Paladon 65) resin materials were evaluated. Flexural strength, E-modulus, Vickers hardness, fracture toughness, fracture work, water sorption, and water solubility were measured. Samples were evaluated after dry and water storage for 30 days at 37 °C. Data were collected and statistically analyzed.

RESULTS

Under both storage circumstances, the flexural strength values of Paladon 65, Therapon Transpa, Temp Premium Flexible Transpa, and Aqua were statistically non-significant (P=0.055). The polycarbonate-based CAD-CAM material Temp Premium Flexible Transpa had the highest statistically significant values of the fracture toughness and fracture work (P<0.001). Moreover, it exhibited the lowest percentages of water sorption and water solubility among the investigated materials (P<0.001). All of the CAD-CAM materials exhibited dry elastic moduli greater than Palapress and lower than Paladon 65. One of the CAD-CAM materials, Cast, had the highest dry Vickers hardness value, which was non-significant when compared to Therapon Transpa (P=0.762).

CONCLUSION

CAD-CAM polycarbonate-based splint materials exhibit higher fracture toughness and fracture work as well as lower water sorption and solubility than polymethyl methacrylate-based ones. The mechanical characteristics of the assessed CAD-CAM milled splint materials were not typically superior to those of the conventional heat-polymerized resin. However, some of them outperformed the autopolymerizing acrylic resin in terms of flexural strength, surface microhardness, water sorption, and water solubility.

Evaluation of the mechanical properties and degree of conversion of 3D printed splint material

OBJECTIVE

To evaluate the effect of post-curing method, printing layer thickness, and water storage on the mechanical properties and degree of conversion of a light-curing methacrylate based resin material (IMPRIMO® LC Splint), used for the fabrication of 3D printed occlusal splints and surgical guides.

METHODS

96 bar-shaped specimens were 3D printed (Asiga MAX), half of them with a layer thickness of 100 μm (Group A), and half with 50 μm (Group B). Each group was divided in three subgroups based on the post-curing method used: post-curing with light emitting diode (LED) and nitrogen gas; post-curing with only LED; and non-post-curing. Half of the specimens from each subgroup were water-stored for 30 days while the other half was dry-stored (n = 8). Flexural strength and flexural modulus were evaluated. Additional specimens were prepared and divided in the same way for surface hardness (n = 96), fracture toughness, and work of fracture (n = 96). Five specimens were selected from each subgroup for evaluating the degree of conversion (DC). Data were collected and statistically analyzed with 1-way, 2-way ANOVA, and Tukey post-hoc analysis (α = 0.05).

RESULTS

The 2-way ANOVA showed that the post-curing method and water storage significantly affected the investigated mechanical properties (P < 0.001). The 1-way ANOVA revealed a statistically significant difference among the tested groups on the investigated properties (P < 0.001). After water storage, the 100 μm subgroup post-cured with only LED showed higher flexural strength (51 ± 9) than the 50 μm and 100 μm subgroups that were post-cured with LED in addition to nitrogen gas atmosphere (38 ± 5, 30 ± 3) (p < 0.05). The 50 μm subgroup post-cured with only LED showed the highest significant flexural modulus values (1.7 ± 0.08) (p < 0.05). However, the 50 μm subgroup post-cured with LED plus nitrogen showed significantly higher surface hardness values (p < 0.05) among the investigated groups. The non-post-cured subgroups showed the lowest values, which were significantly different from the other subgroups (p < 0.05).

CONCLUSION

The post-curing method, water storage, and printing layer thickness play a role in the mechanical properties of the investigated 3D Printed occlusal splints material. The combination of heat and light within the post-curing unit can enhance the mechanical properties and degree of conversion of 3D printed occlusal splints. Flexural strength and surface hardness can increase when decreasing printing layer thickness.

Evaluation of prolotherapy in comparison with occlusal splints in treating internal derangement of the temporomandibular joint - A randomized controlled trial

PURPOSE

The aim of this study was to compare the efficacy of dextrose prolotherapy with that of occlusal splints in treating internal derangement of the temporomandibular joint.

PATIENTS AND METHODS

A total of 34 patients with temporomandibular joint internal derangement classed as Wilkes stages II or III were recruited for the study, and were randomly divided into study and control groups with 17 patients each. The patients in these control and study groups were treated with splints and prolotherapy, respectively. Outcome parameters, such as pain, mouth opening, clicking and deviation, were assessed using the Helkimo clinical dysfunction index for a review period of 1 year.

RESULTS

Nine patients in the study group had complete absence of pain, compared with only one patient in the control group. The results showed that patients who received prolotherapy demonstrated improvement in pain (p < 0.001), mouth opening (p = 0.032), and clicking (p < 0.001), but no significant difference in deviation was observed between the groups after 1 year (p = 0.862).

CONCLUSION

Prolotherapy was found to be superior in providing long-term clinical relief, with reduction in pain and clicking along with improved mouth opening.

Efficacy of Half-length vs. Standard-sized Short Arm splint in Soft Tissue Injuries of the Hand and Wrist: a Randomized Controlled Trial

Introduction:

Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease.

Objective:

The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint.

Method:

In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three.

Results:

A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92).

Conclusion:

In this study, half-length short arm splints were found to be as effective as standard short arm splints.

Effects of Treatment with Nociceptive Trigeminal Inhibition Splints on Electromyography in Temporomandibular Joint Disorder Patients

AIM

This research aimed at evaluating the effects of the nociceptive trigeminal inhibition splint (NTIS) on electromyography (EMG) for masseter and temporalis muscles in patients with temporomandibular joint disorders (TMDs), and at detecting the discomfort degree originating from this splint.

MATERIALS AND METHODS

The sample consisted of 15 patients having TMDs of muscular origin to be treated by NTIS. The activity degree of masseter and temporalis muscles was measured using the EMG two times: before the treatment and after 6 months. Besides, patients' discomfort was assessed after the start of treatment four times: 1 day, 2 weeks, 1 month, and 6 months.

RESULTS

After the treatment, there was a significant decrease in masseter and temporalis muscles' activity in both right and left sides (p < 0.001). No significant differences were observed in the electrical muscular activity mean change between the masseter muscles (-43.87 ± 26.82) and the temporalis muscles (-54.91 ± 21.16) (p = 0.082), or between the right muscles (-51.97 ± 26.30) and the left muscles (-46.81 ± 22.90) (p = 0.422). In addition, the discomfort degree gradually decreased after 2 weeks (p < 0.01).

CONCLUSION

The use of NTIS is associated with reduction in the masseter and temporalis muscles' activity. Also, the patients' discomfort degree from NTIS progressively decreases after 2 weeks of treatment.

CLINICAL SIGNIFICANCE

The NTIS is an effective therapeutic approach for patients having TMDs of muscular origin.

Effectiveness of splinting for pain and function in people with thumb carpometacarpal osteoarthritis: a systematic review with meta-analysis

OBJECTIVE

To examine the effectiveness of splinting for reducing pain and improving function and health-related quality of life (HR-QoL) in people with thumb carpometacarpal osteoarthritis (CMC OA).

DESIGN

The Cochrane Library, MEDLINE, Embase, CINAHL, ISI Web of Science, Scopus and Google Scholar, 3 trial registries and 4 conference proceedings were systematically searched for randomised and non-randomised controlled trials up to March 17th, 2018. Two reviewers independently applied the inclusion criteria to select potential studies and assess risk of methodologic bias using the Cochrane Collaboration's Risk of Bias Tool. Studies were pooled using the inverse variance method to calculate standardised mean difference (SMD). Sensitivity analyses were conducted and the quality of evidence for each outcome was judged following the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Twelve studies were retrieved (n = 1353), 4 comparing a splint to control and 8 to another splint. In the medium-term (3-12 months), low quality evidence showed that splints cause a moderate to large reduction in pain (SMD 0.7 [95% confidence interval (CI) 1.04, 0.35], P < 0.0001) and small to moderate improvement in function (SMD 0.42 [95% CI 0.77, 0.08], P = 0.02). No significant effect was found at short-term or for different types of splints. No studies reported HR-QoL.

CONCLUSIONS

Splinting demonstrated a moderate to large effect for pain and small to moderate effect for function in the medium-term but not in the short term. Quality of the evidence is low. Major challenges are the lack of diagnostic criteria and of a gold-standard outcome measure for thumb CMC OA.

The Horizontal Root Fractures. Diagnosis, Clinical Management and Three-Year Follow-Up

Objective:

The aim of this retrospective analysis is to describe and to evaluate the middle third horizontal root fractures, long term clinical management results and to estimate the effect of treatments factors upon healing and survival rate.

Methods:

Our clinical study included 42 patients presenting a middle third horizontal root fracture in permanent dentition. For each patient at t₀ the parameters recorded were: diastasis, mobility, sensibility, periodontal inflammation, pulpal pathology, associated fracture and dislocation of the coronal fragment. The follow-up was performed after 6 (t1), 12 (t2) and 36 (t3) months after the trauma, both clinically and radiologically. Clinical examination, vitality tests and a radiological evaluation (periapical x-ray) were performed.

Results:

At t₀ it was observed: diastasis (14, 3%), mobility (28, 6%), thermal sensibility (61, 9%), periodontal inflammation (4, 8%), pulpal pathology (38, 1%) and dislocation of the coronal fragment (47, 6%) of the patients. The treatment plan started with the coronal fragment repositioning and the blockage (splint) with the adjacent teeth in 47, 6% of cases.

A root canal treatment was performed at t₀ in 52,4% of the fractured teeth. Statistical analysis showed the highest level of significance between pulpal lesions (t₀) and associated fractures. The mobility, sensibility and pulpar lesions parameters, showed a reduction in relation to the follow up timing, with a main variation remarkably evident between t₀ and t1. The ratio between observation time and the presence of diastasis was statistically significant.

Conclusion:

The analysis of the clinical results exhibits the high success rate of a conservative approach in the treatment of teeth fractured in the middle third of the root.

A retrospective study of traumatic dental injuries in primary dentition: treatment outcomes of splinting

OBJECTIVE

Splinting in primary dentition is limited to several traumatic dental injuries. The prognosis associated with splint use has not been fully investigated. In this study, we investigated the outcomes of traumatic injuries in primary teeth treated with splinting.

MATERIALS AND METHODS

We retrospectively analysed 137 children with root fractures and lateral and extrusive luxation injuries to their primary teeth who were treated with semi-rigid splints between 2010 and 2016. Treatment outcomes were analysed in patients with follow-up periods of >6 months. The outcomes of splinting were based on clinical and radiographic evaluations performed during follow-up examinations.

RESULTS

In total, 182 primary teeth were examined, and of these, 90 teeth were treated using semi-rigid splints. In the splint group, pathological root resorption (31.1%) was the most common complication, whereas pathological tooth loss (25.0%) was found most common in the observation group. Splinting in root fractures showed a good prognosis, whereas in lateral and extrusive luxations, it did not (p < .05). There were no relationship between treatment delay and prognosis (p > .05).

CONCLUSIONS

Depending on the type of luxation, splint therapy results in acceptable outcomes and may be a feasible treatment option.

Acute hand injury splinting - the good, the bad and the ugly

Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting. This article aims to provide guidance for frontline staff on the management of hand fractures, with particular emphasis on the appropriate nonoperative care to avoid any unnecessary morbidity.

History of intranasal splints

OBJECTIVE

Intranasal splints have long been utilised as a post-operative adjunct in septoplasty, intended to reduce the risk of adhesions and haematoma formation, and to maintain alignment during healing.

METHODS

A Medline literature review of the history and evolution of intranasal splint materials and designs was performed. Advantages and disadvantages of various splints are discussed.

RESULTS

Intranasal splints fashioned from X-ray film were first reported in 1955. Since then, a variety of materials have been utilised, including polyethylene coffee cup lids, samarium cobalt magnets and dental utility wax. Most contemporary splints are produced from silicon rubber or polytetrafluoroethylene (Teflon). Designs have varied in thickness, flexibility, shape, absorption and the inclusion of built-in airway tubes. Future directions in splint materials and designs are discussed.

CONCLUSION

Intranasal splints have steadily evolved since 1955, with numerous novel innovations. Despite their simplicity, they play an important role in nasal surgery and will continue to evolve over time.

Position of Mandibular Condyles during Stabilization Splint Wearing

The purpose of this study was to determine the position of mandibular condyles during wearing of stabilization splints with different thickness. Two stabilization splints were made for 10 completely dentate participants. First splint was made with minimal 1 mm distance at molar area between the upper and lower teeth, while the second splint was made 3 mm higher than the first splint. Condylar position measurements during splint wearing were done using ultrasound jaw tracking device with six degrees of freedom at the antero-posterior (x), vertical (y) and lateral (z) axes. Linear deviation values were calculated from the values of the Cartesian coordinate system. The mean value of linear deviation between the habitual occlusion and the occlusion with stabilization splint made at 1 mm distance in molar area was 2.04±1.18 mm, while with stabilization splint made 3 mm higher than the first one it was 2.32±1.24 mm. Independent samples T test did not confirm statistically significant difference in deviation values between the splints of different thickness. Raising stabilization splint height does not change significantly the position of the condyle within the temporomandibular joint. Higher condylar distraction in the temporomandibular joint cannot be expected with 'thicker' stabilization splint.

[Pediatric clubfoot : Treatment of recurrence]

Over the last 10 years the Ponseti method has become established as the gold standard for initial treatment of clubfeet nearly worldwide. Nevertheless, there are considerable fluctuations regarding the authenticity and quality in the application of the Ponseti method. Especially the efforts to ensure and promote compliance with the foot abduction brace and subsequently the recurrence rate show great variation. As a result, we are still faced with a significant number of recurrent or residual clubfeet. In recent years it has been shown in high-volume clinics that even these can almost always be successfully treated with recasting and with minor interventions, such as anterior tibial tendon transfer and lengthening of the Achilles tendon. More invasive surgical procedures are only very rarely indicated and are reserved for severe recurrence in previously surgically treated and secondary clubfeet.

The role of two-sided splinting for recalcitrant paediatric post-burn hand flexion contracture: a case report

A 2-year-old boy presented to the plastic and reconstructive surgery outpatient clinic with bilateral post-burn hand flexion contracture. The contracture had been released twice elsewhere. The third surgical repair on one hand at a time was conducted by the author (TOHP). However, inadeq.uate compliance to the postoperative splinting and exercise led to the recurrence of the contracture in the following year. A customised two-sided splint was therefore created to ensure proper placement and compliance. Reinforcement to the parents to encourage the boy to practise active exercise on demand was also an integral part of the management. Good functional and cosmetic outcome were presented at 1-year follow-up. This case highlights the value of a two-sided splint for the management of post-burn hand flexion contracture in children whose compliance is inevitably cannot be guaranteed.

The effects of arthritis gloves on people with Rheumatoid Arthritis or Inflammatory Arthritis with hand pain: a study protocol for a multi-centre randomised controlled trial (the A-GLOVES trial)

Background

Arthritis gloves are regularly provided as part of the management of people with rheumatoid arthritis (RA) and undifferentiated (early) inflammatory arthritis (IA). Usually made of nylon and elastane (i.e. Lycra®), these arthritis gloves apply pressure with the aims of relieving hand pain, stiffness and improving hand function. However, a systematic review identified little evidence supporting their use. We therefore designed a trial to compare the effectiveness of the commonest type of arthritis glove provided in the United Kingdom (Isotoner gloves) (intervention) with placebo (control) gloves (i.e. larger arthritis gloves providing similar warmth to the intervention gloves but minimal pressure only) in people with these conditions.

Methods

Participants aged 18 years and over with RA or IA and persistent hand pain will be recruited from National Health Service Trusts in the United Kingdom. Following consent, participants will complete a questionnaire booklet, then be randomly allocated to receive intervention or placebo arthritis gloves. Within three weeks, they will be fitted with the allocated gloves by clinical specialist rheumatology occupational therapists. Twelve weeks (i.e. the primary endpoint) after completing the baseline questionnaire, participants will complete a second questionnaire, including the same measures plus additional questions to explore adherence, benefits and problems with glove-wear. A sub-sample of participants from each group will be interviewed at the end of their participation to explore their views of the gloves received. The clinical effectiveness and cost-effectiveness of the intervention, compared to placebo gloves, will be evaluated over 12 weeks. The primary outcome measure is hand pain during activity. Qualitative interviews will be thematically analysed.

Discussion

This study will evaluate the commonest type of arthritis glove (Isotoner) provided in the NHS (i.e. the intervention) compared to a placebo glove. The results will help occupational therapists, occupational therapy services and people with arthritis make informed choices as to the value of arthritis gloves. If effective, arthritis gloves should become more widely available in the NHS to help people with RA and IA manage hand symptoms and improve performance of daily activities, work and leisure. If not, services can determine whether to cease supplying these to reduce service costs.

Trial registration

ISRCTN Registry: ISRCTN25892131 Registered 05/09/2016

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1583-4) contains supplementary material, which is available to authorized users.

Effectiveness of Ear Splint Therapy for Ear Deformities

OBJECTIVE

To present our experience with ear splint therapy for babies with ear deformities, and thereby demonstrate that this therapy is an effective and safe intervention without significant complications.

METHODS

This was a retrospective study of 54 babies (35 boys and 19 girls; 80 ears; age ≤3 months) with ear deformities who had received ear splint therapy at the Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University Hospital between December 2014 and February 2016. Before the initiation of ear splint therapy, ear deformities were classified with reference to the standard terminology. We compared the severity of ear deformity before and after ear splint therapy by using the physician's ratings. We also compared the physician's ratings and the caregiver's ratings on completion of ear splint therapy.

RESULTS

Among these 54 babies, 41 children (58 ears, 72.5%) completed the ear splint therapy. The mean age at initiation of therapy was 52.91±18.26 days and the treatment duration was 44.27±32.06 days. Satyr ear, forward-facing ear lobe, Darwinian notch, overfolded ear, and cupped ear were the five most common ear deformities. At the completion of therapy, the final physician's ratings of ear deformities were significantly improved compared to the initial ratings (8.28±1.44 vs. 2.51±0.92; p<0.001). There was no significant difference between the physician's ratings and the caregiver's ratings at the completion of ear splint therapy (8.28±1.44 vs. 8.0±1.61; p=0.297).

CONCLUSION

We demonstrated that ear splint therapy significantly improved ear deformities in babies, as measured by quantitative rating scales. Ear splint therapy is an effective and safe intervention for babies with ear deformities.

Comparison Study of the Use of Absorbable Materials as Internal Splints with Airway Silicone Splint and Absorbable Materials as Internal Splints Alone

Background

Packing after closed reduction of nasal fracture causes uncomfortable nasal obstruction in patients. We packed the superior meatus with synthetic polyurethane foam (SPF) to support the nasal bone, and packed the middle nasal meatus with a nasal airway splint (NAS) and SPF. The aim of this article is prospectively to compare the subjective patient discomfort of SPF (Nasopore Forte plus) packing alone and SPF with NAS.

Methods

We compared the prospectively subjective patient discomfort of SPF packing alone (group A) and SPF with NAS (group B) via visual analog scale (VAS; 0, no symptom; 100, most severe symptom).

Results

At first postoperative day group B showed significant lower scores in dry mouth, sleep disturbance, conversation difficulty. However at third postoperative day, VAS scores of each group had no statistically significant differences. Moreover at fifth postoperative day group A had statistically significant lower scores for nasal pain, dry mouth than the group B.

Conclusion

Combination method of using NAS and SPF have some advantage on the patient comfort from first postoperative day to third postoperative day.

Combined treatment with paraffin, manual therapy, pegboard and splinting in a patient with post-traumatic stiff hand

Background

The stiff hand is a still common, severe complication of hand injuries.

Case presentation

We report here the case of a 56 year-old woman, professional goldsmith, who suffered a distal radius fracture of her right hand. The patient was treated with surgery followed by four weeks of immobilization, and developed a stiff hand. Physical examination showed mild inflammatory signs, pain and a major limitation in the extension and supination of the wrist, and in the mobility of the II, III, IV and V metacarpophalangeal (-5° and 32° of average passive extension and flexion, respectively) and interphalangeal (-35° and 73° of average passive extension and flexion, respectively) joints. There was a lack of slip of the flexor tendons. The diagnosis of complex regional pain syndrome was considered although it could not be definitely established. After five months of adverse evolution the patient was referred to our center where a combined intervention with paraffin, manual therapy, prolonged active and passive stretch on a pegboard, and splinting was applied. After initiation of this therapy, a marked change in the evolution of the pain, the mobility and functionality of the hand was observed. At the end of the rehabilitation program the patient was able to fully resume her job.

Conclusion

The present case illustrates the need of intensive treatment for post-traumatic hand stiffness, and describes, as an original contribution, a combined intervention therapy including paraffin, manual therapy, pegboard and splinting.

[Hand rehabilitation after distal radius fracture]

Distal radius fractures (DRF) are common. Good outcomes are the result of appropriate initial treatment (immobilization, external fixation, percutaneous pinning or open reduction and internal fixation) and rehabilitation adapted to this treatment. When started immediately, rehabilitation of DRF prevents complications due to immobilization, surgery and a non-controlled healing process. Splints play an important role at all stages of rehabilitation.

Needle aponeurotomy for Dupuytren contracture: Effectiveness of postoperative night extension splinting

BACKGROUND

Night extension splinting has been used to treat patients with Dupuytren contracture to improve active range of motion (AROM) of the hand. A published case study demonstrated the benefit of splinting following needle aponeurotomy; however, no larger studies have evaluated the impact of postoperative splinting.

OBJECTIVES

To compare the impact of night extension splinting on AROM, specifically extension, following needle aponeurotomy for Dupuytren contracture.

METHODS

A retrospective chart review was conducted in which the charts of 53 patients who underwent needle aponeurotomy for Dupuytren contracture between 2009 and 2013 were reviewed. The control group consisted of patients who underwent needle aponeurotomy only, whereas the treatment group was also referred for fabrication of custom night extension splints after surgery. Comparisons in pre- and postoperative AROM measurements for the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were made between both groups of patients. The degrees of change in AROM for each joint were categorized in terms of levels of change: mild (0° to 29°); moderate (30° to 60°); and significant (≥61°).

RESULTS

All patients exhibited increased AROM after surgery for both MCP and PIP joints. Both groups had a greater increase in AROM in the MCP joint. Twelve joints from the control group had moderate changes and two from the treatment group had significant changes. When both groups were compared, the levels of change of AROM between both groups did not vary significantly.

CONCLUSION

Night extension splinting following needle aponeurotomy may not improve AROM of the MCP or PIP joints.

Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors

BACKGROUND

To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture.

METHODS

A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into 'early' and 'late' categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement.

RESULTS

Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003).

CONCLUSIONS

Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly.

Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors

BACKGROUND

To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture.

METHODS

A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into 'early' and 'late' categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement.

RESULTS

Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003).

CONCLUSIONS

Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly.

Custom-Made Finger Orthoses Have Fewer Skin Complications Than Prefabricated Finger Orthoses in the Management of Mallet Injury: A Systematic Review and Meta-Analysis

OBJECTIVE

To investigate which orthosis results in (1) fewer complications; (2) the least extensor lag; and (3) the highest rates of treatment success according to the Abouna and Brown criteria for soft tissue mallet injury in adults.

DATA SOURCES

Electronic databases AMED, CINAHL, Embase, MEDLINE, PubMed, OTseeker, and PEDro were searched from the earliest available date until September 16, 2014.

STUDY SELECTION

Controlled trials evaluating orthosis type in the conservative management of mallet injury were included. Database searching yielded 1024 potential studies, of which 7 met inclusion criteria with a total of 491 participants.

DATA EXTRACTION

Data were extracted using an author-designed extraction form by one reviewer, and accuracy was assessed by a second reviewer. The PEDro scale was used to assess methodological quality.

DATA SYNTHESIS

Results were pooled using a random-effects model with inverse variance methods. Dichotomous outcomes are expressed as risk ratios (RRs) and 95% confidence intervals (CIs) and continuous outcomes as standardized mean differences and 95% CIs. There is moderate quality evidence that prefabricated orthoses had 3 times the risk of developing skin complications as compared with all other orthoses (RR, 3.17; 95% CI, 1.19-8.43; I(2)=47%) and nearly 7 times the risk of developing skin complications as compared with custom-made thermoplastic orthoses (RR, 6.72; 95% CI, 1.59-28.46; I(2)=0%). Treatment outcomes were found to be similar for treatment success when prefabricated orthoses were compared with custom-made orthoses (RR, .99; 95% CI, 0.80-1.22; I(2)=39%; very low quality evidence), as well as for extensor lag when custom-made thermoplastic orthoses were compared with other orthoses (standardized mean difference, .03; 95% CI, -.29 to .36; I(2)=0%; moderate quality evidence).

CONCLUSIONS

Prefabricated orthoses were found to increase the risk of developing skin complications as compared with custom-made orthoses, but there were no differences in treatment success, failure, or extensor lag.

Comparison study of the use of absorbable and nonabsorbable materials as internal splints after closed reduction for nasal bone fracture

Background

The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel) and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus) as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period.

Methods

The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A) or SPF (group B) was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed.

Results

PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A.

Conclusions

The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.

Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants

BACKGROUND

Uncorrected developmental dysplasia of the hip (DDH) is associated with long-term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.

OBJECTIVES

To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.

SEARCH METHODS

Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants.

SELECTION CRITERIA

Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.

DATA COLLECTION AND ANALYSIS

Three independent review authors assessed study eligibility and quality, and extracted data.

MAIN RESULTS

No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment. One study reported universal ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery but was associated with a significant increase in treatment. One study reported targeted ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery, with no significant difference in rate of treatment. Meta-analysis of two studies found universal ultrasound compared to targeted ultrasound did not result in a significant reduction in late diagnosed DDH or surgery. There was heterogeneity between studies reporting the effect on treatment rate. Meta-analysis of two studies found delayed ultrasound and targeted splinting compared to immediate splinting of infants with unstable (but not dislocated) hips resulted in no significant difference in the rate of late diagnosed DDH. Both studies reported a significant reduction in treatment with use of delayed ultrasound and targeted splinting. One study reported delayed ultrasound and targeted splinting compared to immediate splinting of infants with mild hip dysplasia on ultrasound resulted in no significant difference in late diagnosed DDH but a significant reduction in treatment. No infants in either group received surgery.

AUTHORS' CONCLUSIONS

There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.

PLAIN LANGUAGE SUMMARY

Screening methods for dislocated or improperly formed hips in newborn infants The hip joint is a ball and socket joint. Newborns may have hips that are not in their socket (dislocated) or hips that are improperly formed (dysplasia). Risk factors for hip dysplasia include a family history of a similar problem and female infants delivered in the breech position. The hips of most newborns will be examined clinically after birth and during infancy to determine whether they are stable, unstable or dislocated. Screening for hip dysplasia may prevent the need for late treatment, which is associated with long term hip deformity, gait disturbance and arthritis. However, early screening leads to increased treatment. Treatment may be complicated by damage to the hip due to impairment of the blood supply (avascular necrosis). This review found no studies that compared the benefits and costs of early screening versus not screening for hip problems. Studies that compared the addition of ultrasound to clinical examination reported that when ultrasound was performed on all infants, the rate of treatment increased with no significant difference in rate of late detected dysplasia or surgery. Targeted ultrasound to infants at high risk of hip dysplasia did not significantly increase the rate of treatment but also did not significantly reduce the rate of late detected dysplasia or surgery. It is not possible to give clear recommendations for hip screening of newborn infants from the available evidence. Where infants are clinically detected as having unstable but not dislocated hips, or are detected on ultrasound to have mild hip dysplasia, there is evidence that delaying treatment by two to eight weeks reduces the need for treatment without a significant increase in late diagnosed dysplasia or surgery.

Applications of finite element simulation in orthopedic and trauma surgery

Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied to the correction of deformities, providing the recovering force-displacement and angle-moment curves that characterize the mechanical behavior of the splint in the overall range of movement.