Case report illustrating use of serial elastic tension digital neoprene orthoses (ETDNO) protocol in the treatment of proximal interphalangeal joint flexion contracture

Abstract

IntroductionThis case report details the application of a treatment regimen using a serial elastic tension digital neoprene orthosis (ETDNO) protocol for a patient with an eight-month-old finger crush injury who experienced recurrence of a 45º proximal interphalangeal joint (PIPJ) flexion contracture two months after arthrolysis. Purpose of the StudyTo illustrate how the application strategy of ETDNO can increase the daily total end range time (TERT) and modify finger stiffness. ResultsThe patient reached full extension following 15 weeks of ETDNO treatment. The six-month follow-up evaluation revealed that the PIPJ was stable with full flexion and extension. The joint did not require continued orthosis use. DiscussionThe literature describes orthosis application as the treatment of choice for PIPJ flexion contracture, but no study has described an ideal program for use nor the full and stable resolution of the flexion contracture. The current literature describes a maximum daily total end range time (TERT) of 12 hours a per day. The serial ETDNO protocol that this study described increased the daily TERT to nearly 24 hour per day and demonstrated an excellent result in the treatment of PIPJ flexion contracture ConclusionThis outcome suggests that clinicians will want to consider this new orthosis design and management protocol as a novel option for the treatment of PIPJ flexion contracture. We need future research to better define the optimum number of hours of daily TERT for the effective treatment of PIPJ flexion contracture. In addition, we will also benefit from the exploration of the optimum orthosis design to enable the highest amount of TERT