Dynamic Splinting Research Articles

Comparison of functional results after early controlled motion for surgical repair of acute and chronic ulnar collateral ligament injury of the thumb

Injuries to the UCL can lead to functional impairment. Rehabilitation is very important for functional results. Early motion after surgery is avoided. Usually the controlled motion starts after the 6th week. The aim of this study was to evaluate functional results of early controlled motion before 6th week. Nineteen patients (18♂/1♀) had an acute UCL rupture, 25 patients (23♂/2♀) had a chronic UCL rupture. Two soft anchors (Mini 1.0 mm) were used to repair ruptured UCL to bone insertion at the acute UCL injury group. For chronic UCL injury group, 3.0 mm bone tunnels were prepared to proximal and distal insertion of UCL and than tendon graft was passed through the tunnels. The tendon graft was stabilized by placing 3.0-mm bioabsorbable suture anchors within the tunnels. The motion was restricted in the 2 week with thumb spica. Dynamic splint and passive ROM exercises were started after 2 week. Active ROM exercises were started after 4 week. There were no significant differences between the two groups in the men/women ratio, mean age, mean follow-up period. All patients regained full stability at MCP joint in acute UCL injury group; 21 patients regained full stability and 4 patients presented with mild laxity (< 10° laxity) in chronic UCL injury group. The ROM of injured MCP joint of thumb was regained at 8–10 week as good as healthy extremity MCP joint of thumb. There were no significant differences between operated and healthy thumb MCP joint in both groups in the grip and pinch strength, flexion, extension, radial deviation, ulnar deviation motions at final control. Glickel grading scale was excellent for 19 patients for acute UCL injury group; it was excellent for 21 patients and good for 3 patients in chronic UCL injury group. Early controlled motions affect functional results positively. Repair with 1-mm soft anchors in acute UCL injury and reconstruction with tendon graft which stabilized by 3-mm bioabsorbable suture anchors within the tunnels in chronic UCL injury provides adequate stability for early controlled motion.

Olecranon Osteotomy-Facilitated Elbow Release (OFER).

The olecranon osteotomy-facilitated elbow release (OFER) is a safe and effective method for releasing severe posttraumatic elbow contractures. The OFER procedure is easier, faster, and relatively less invasive, and appears to offer superior outcomes, compared with more traditional techniques. An olecranon osteotomy provides a trapdoor through which the surgeon will have circumferential access to the joint and will be able to address all intrinsic and extrinsic causes of contracture. Access from the posterior to the anterior compartment is achieved by detaching the origin of the medial collateral ligament (MCL) and hinging the joint from medially to laterally, pivoting around the intact lateral collateral ligament. Once the olecranon and MCL are repaired, the elbow is stable enough for the patient to participate in intensive rehabilitation protocols. The first line of treatment for elbow contracture is physical therapy, focusing on range of motion and using modalities such as static-progressive and dynamic splinting protocols. In some select cases, there is also a role for manipulation under anesthesia. When nonoperative methods fail, elbow contractures may be treated surgically, using either open or arthroscopic techniques. Authors have described open release involving medial, lateral, and anterior approaches. The first outcome report of a posterior approach to treat elbow contractures has recently been published1. An open approach usually utilizes 1 or possibly 2 large incisions and involves invasive dissection through muscle and nerve mobilization. This may result in a postoperative hematoma and usually substantial pain, posing a challenge for rehabilitation. Arthroscopic techniques are less invasive, with potentially fewer complications, but are far more technically challenging. Also, most extrinsic and some intrinsic causes cannot be adequately addressed through the arthroscope. The outcomes of OFER have been found to be superior to those reported after either arthroscopic or more conventional open procedures. In addition, we believe that the OFER procedure is substantially faster and technically easier than either other open or arthroscopic releases, although we are not aware of any studies addressing this topic.

The "Sparti" splint for rehabilitation of extensor tendon injuries in zones V-VII.

Dynamic splinting is a well-known method for maintaining finger movement after ruptures of the extensor tendons. We describe a simple, inexpensive and easy-to-construct modification of a dynamic splint, called the "Sparti" splint, suitable for a six-week period of rehabilitation of injured extensor tendons in zones V-VII.

Early Functional Treatment of Proximal Phalanx Fractures in Children: A Case Series Study.

The objective of this study was to assess proper indications a nonsurgical treatment regime for pediatric fractures of the proximal phalanx based on principles of early functional treatment. A case series (evidence level 4) of 30 pediatric patients with fractures of the proximal phalanx were treated nonsurgically using protective dynamic splinting techniques and fiberglass casting material. Assessments were performed clinically and by x-ray within 4 to 8 weeks of commencement of treatment. Outcome measures included Disabilities of the Arm, Shoulder, and Hand score questionnaire as well as fingertip palm distance (cm) and dynamic pain interval assessments. All fractures healed without any clinically apparent bony deformities. Disabilities of the Arm, Shoulder, and Hand scores were of 25.17 ± 5.29 (mean ± SD), which indicated good functional results usually within 2 weeks of removal of dynamic splints. Fingertip palm distance measurements at endpoints were of 0.17 ± 0.27 cm (mean ± SD), which indicated an almost free range of finger motion. Absence of pain perception under active finger motion (dynamic pain interval) was noted at 14.10 ± 6.79 days (mean ± SD). Well-established criteria for surgical treatment of phalangeal fractures exist. However, in our experience, a majority of pediatric fractures of the proximal phalanx can be safely treated nonsurgically with dynamic splinting along with shorter intervals of immobilization of the affected fingers and faster restoration of overall hand function compared to surgical treatment.

Dynamic Splinting in Children and Adolescents With Stiffness After Knee Surgery.

The purpose of this study was to investigate the indications and outcomes of dynamic splinting (DS) of the arthrofibrotic knee in the pediatric population. Seventy-four patients (41 males, 33 females) with postoperative arthrofibrosis treated with DS after an index knee surgery were reviewed. Median age was 13 years (range, 4 to 18 y), and median follow-up was 17 months (interquartile range, 10 to 28 mo). Demographics, index surgery procedure, preoperative and postoperative knee range of motion (ROM) measurements, treatment length and subsequent need for manipulation under anesthesia (MUA), and surgical lysis of adhesions (LOA) were evaluated. A ROM deficit was defined as lack of extension ≥10 degrees or lack of flexion <130 degrees. Successful improvement of ROM was defined as an increase of ≥10 degrees in flexion, extension, or both. There were 23 patients with flexion deficit only, 17 with extension deficit only, and 34 with combined flexion and extension deficits. Wilcoxon signed-rank test was used to assess median improvement in ROM. Patients were classified into 4 surgical groups: anterior cruciate ligament (ACL) reconstruction without meniscal repair (n=19), ACL reconstruction with meniscal repair (n=12), tibial spine fracture repair (n=21), and other (n=22). Multivariable logistic regression was used to identify independent predictors of failure of DS requiring MUA and LOA. A total of 57 patients with flexion deficits showed median improvement of 30 degrees in flexion (95% confidence interval, 0-90 degrees; P<0.001), and 51 patients with extension deficits showed median improvement of 7 degrees in extension (95% confidence interval, 0-60 degrees; P<0.001). DS was associated with ROM improvement in 84% and avoided the need for surgery in 58% of all 74 patients included in the study. Multivariate analysis of the ACL with meniscus repair subgroup revealed that each 1-month delay in DS treatment was associated with a 5-fold increased risk of undergoing a LOA (P=0.007). Thirty-six (63%) patients with flexion deficit avoided need for surgery, whereas 26 (51%) patients with extension deficits avoided surgery. Our data suggest that DS is an effective method to increase knee ROM and reduce the need for subsequent MUA/LOA in the pediatric and adolescent patient with arthrofibrosis after an index knee surgery. Level IV-retrospective case series.

A dynamic splint for the treatment of spasticity of the hand after stroke? Recognition of its design, functionality and limitations: A narrative review article

Occurrence of spasticity of the hand after a stroke event is recognized as a major cause of functional limitations which reduces the quality of life in patients. Dynamic splints are among the alternative rehabilitation treatments for reducing spasticity of the hand. However, evidence supporting their effectiveness in restoring hand functionality, their long-term and short-term effects is limited. Moreover, standardized methods of designing dynamic splints are currently lacking. This review describes the methods used to design dynamic splints, their functionality and the current issues surrounding their application to post-stroke patients with spasticity of upper limbs. In so doing, we provide the foundational knowledge which may be tested in future clinical trials and in splint edifications to enhance the efficiency of splints to improve the quality of life in stroke patients. When properly designed to fit a patient, a dynamic splint can promote the functional recovery of a spastic hand. Further research is required to deepen our understanding on the clinical utility of dynamic splints in post-stroke patients to optimize their recovery outcomes

Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial

BackgroundThe elbow is prone to stiffness after trauma. To regain functional elbow motion several conservative- and surgical treatment options are available. Conservative treatment includes physical therapy, intra-articular injections with corticosteroids and a static progressive or dynamic splinting program. If conservative treatment fails, an operative release of the posttraumatic stiff elbow is often performed. The best Evidence-Based rehabilitation protocol for patients after an operative release is unknown to date and differs per surgeon, hospital and country. Options include early- or delayed motion supervised by a physical therapist, immediate continuous passive motion (CPM), (night) splinting and a static progressive or dynamic splinting program.Methods/designThe SET-Study (Stiff Elbow Trial) is a single-centre, prospective, randomized controlled trial. The primary objective of this study is to compare the active Range of Motion (ROM) (flexion arc and rotational arc) twelve months after surgery between three groups. The first group will receive in-hospital CPM in combination with early motion Physical Therapy (PT) supervised by a physical therapist, the second group will receive only in-hospital early motion PT supervised by a physical therapist and the third group will receive outpatient supervised PT from postoperative day seven till ten. Secondary outcome measures will be Patient Reported Outcome Measures (PROMs) including the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), the quick Disabilities of Arm, Shoulder and Hand (qDASH) score, Visual Analogue pain Scale in rest and activity (VAS), Pain Catastrophizing Scale (PCS), the Short Form (SF)-36, the Centre for Epidemiological Studies Depression Scale Revised (CESD-R) and the Work Rehabilitation Questionnaire (WORQ) for the upper limb.DiscussionA successful completion of this trial will provide evidence on the best rehabilitation protocol in order to (re)gain optimal motion after surgical release of the stiff elbow.Trial registrationThe trial is registered at the Dutch Trial Register: NTR6067, 31–8-2016.

Determination of the Effect of Hallufix Splint on Hallux Valgus Angle in Subjects with Mild and Moderate Hallux Valgus Compared with Night Splint: A Double-Blind Clinical Trial

Introduction: Hallux valgus is one of the most common foot disorders which is the subluxation of the first metatarsophalangeal (MTP) joint due to lateral deviation of the great toe and medial deviation of the first metatarsal bone. The most common interventions in cases with mild to moderate deformity is the use of orthosis which includes two types of splints, dynamic splint for daily use and static splint to be used during the night. The aim of this study was to compare the effect of hallufix dynamic splint on hallux valgus angle in subjects with mild and moderate hallux valgus with night splint. Materials and Methods: This quasi-experimental study was conducted on 34 subjects who had referred to orthopedic specialists in Isfahan and the surrounding towns, Iran, with complaints of hallux valgus. These subjects were divided into two groups of 17 people that were matched in terms of age, gender, and degree of deformity. Then, one group was given night splint and the other group hallufix splint, randomly. Hallux valgus angle was measured using anterior-posterior weight bearing radiograph at baseline and after 6 weeks of orthosis use. Results: The results showed that the use of both orthoses reduced the hallux valgus angle, but this reduction was not statically significant (P > 0.05). In addition, the effect of both splints on the reduction of hallux valgus angle was similar (P = 0.97). Conclusion: The use of night splint and hallufix dynamic splint for 6 weeks did not cause any improvement in hallux valgus angle.

Autogenous palmaris longus tendon grafting for rupture of extensor pollicis longus tendon after distal radius fractures

Background: Secondary rupture of the extensor pollicis longus (EPL) tendon is a known complication following distal radius fracture. While surgical options for EPL tendon tear have been extensively investigated, the surgical results of free tendon graft reconstruction for patients with EPL tendon rupture after distal radius fracture are relatively unexplored. Purpose: We aimed to investigate the outcomes of autogenous palmaris longus (PL) tendon grafting for treating EPL tendon rupture after distal radius fracture. Methods: The study included 9 adult patients (2 male, 7 female; age range, 30-78 years; mean age, 56.7 years) with delayed EPL tendon rupture after distal radius fracture treated at the Taoyuan Armed Forces General Hospital between September 2000 and September 2011. In our hospital, we adopted a protocol for EPL tendon reconstruction that uses the ipsilateral PL tendon. A dynamic splint was applied, and a rehabilitation program including wrist motion and occupational therapy was started within 3 days postoperatively. Extension lag at the interphalangeal joint of the injured thumbs, as well as Geldmacher scores were recorded. Results: At the final follow-up (15-34 months), the extension lag at the interphalangeal joint of the involved thumb had improved significantly (p ＜ 0.05), from a preoperative mean value of 41.7° (range, 35°-60°) to a postoperative mean value of 3.8° (range, 0°-6°). Regarding the Geldmacher scores, 5 patients (55%) achieved ＂excellent＂ results, and 4 (45%) achieved ＂good＂ results. No patients experienced tendon re-rupture, wound infections, nerve injury, or other complications. Conclusions: In this short-term follow-up study, using free PL grafts for treating EPL tendon rupture was found to provide good outcomes, suggesting that tendon grafting using the PL tendon is an effective method to treat delayed EPL tendon rupture after distal radius fracture.

The Role of Dynamic Ultrasound in the Immediate Conservative Treatment of Volar Plate Injuries of the PIP Joint: A Series of 78 Patients

The management of volar plate avulsion fractures in the context of a stable joint and a bony fragment of less than 30% has traditionally been conservative. This study was performed to assess volar plate healing with high-resolution ultrasound in order to provide early full mobilization. Between January 2012 and December 2013, 78 patients with volar plate injuries of the proximal interphalangeal (PIP) joints (42 distortions and 36 dislocations) were treated conservatively in our department for volar plate avulsion fracture associated with stable joint and bony fragment inferior to 30% of the intra-articular surface assessed both by radiography and ultrasound. Conservative treatment included extension stop splinting for the first 2 weeks and Coban bandage until 6 weeks postinjury. However, it may be possible to modify the duration of extension stop splinting based on clinical and ultrasound findings (with no additional X-ray) performed every 2 weeks for the first 3 months and then at 4 months postinjury. Only patients with residual contracture at the 4-month assessment had prolonged follow-up in order to ensure adequate dynamic splint therapy. The amount of soft tissue oedema and the mobility of the volar plate were factors used to determine return to full mobilization. Mean extension-stop-splint wear was 16 ± 2 days. During the first 2 follow-up assessments, 4 patients were excluded from the study because of the instability of the PIP joint. One patient required refixation of a large fragment of 30%, 2 patients required superficial flexor tendon (FDS) tenodesis of the unstable volar plate in hyperextension and 1 other patient required arthrodesis of the PIP joint. In 51 patients, the postoperative follow-up was free of complications at 4 months. In 18 patients, flexion contracture of 20° (range 11°-40°) and oedema during follow-up required dynamic extension splints for 3 to 5 months. After this time, 5 patients had a residual contracture of 10° to 15°. Avulsion fractures of the volar plate at the PIP joint are common. In general, they have a good outcome using the conservative treatment with extension block splints. Flexion contracture is a common complication and may be reduced by immediate splints in full extension at night and Coban bandage during the day. High-resolution sonography is a convenient tool to evaluate palmar plate stability, to assess reduction of oedema, and thus to guide safe return to full range of movement.

Successful treatment of postburn flexion contracture in fingers of early childhood with dynamic splint therapy after operation: long-term follow-up

Infants or early childhood individuals are prone to be burned on the palm and fingers, since they tend to extend their hands to the heat source. Wounds with more than 3-week-prolonged ulcers frequently result in flexion contracture. Despite successful surgery, the outcome might be unsatisfactory because of postoperative contracture. This study aims to investigate the effectiveness of our dynamic splint therapy following operation of postburn flexion contracture of fingers in infants or early childhood. Ten patients with postburn flexion contractures were enrolled in this study. After epithelialization of wounds had been completed, surgery was planned. Contracture was released by scar incision, and full-thickness skin was grafted. Postoperatively, the finger joints were fixed at the extended position with the Kirschner wires for 3 weeks. After the fixation was released, Capener-type dynamic splints were worn for 2 years. The functional outcome was assessed by measurement of total active motion (TAM). The aesthetic outcome was assessed using Vancouver scar scale (VSS). The mean postoperative follow-up period was 49.6 months (range 31–81 months). In all cases, contractures were released, and all skin grafts were completely taken. None developed late contracture. The mean postoperative TAM of the fingers (259.6 ± 2.54) was significantly higher than the preoperative one (148.0 ± 51.5). The mean postoperative VSS (1.40 ± 1.14) was significantly lower than the preoperative one (5.53 ± 0.50). Our treatment protocol provided the excellent functional result and improved the aesthetic appearance. Level of Evidence: Level IV, therapeutic study.

Rehabilitation Regimens Following Surgical Repair of Extensor Tendon Injuries of the Hand—A Systematic Review of Controlled Trials

There is no consensus on the most effective rehabilitation regimen following extensor tendon repair of the hand. This systematic review evaluates the outcomes of the various regimens. The Cochrane, MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker databases were searched for any prospective randomised clinical trials comparing rehabilitation regimens for acute extensor tendon injuries in adults. Five papers met the inclusion criteria. The regimens were static immobilisation, dynamic splinting and early active motion (EAM). There was no standard format of reporting. The sample size ranged from 27 to 100 patients. The duration of follow-up ranged from 8 to 24weeks. Overall, patients' total active motion improved with time. Early mobilisation regimens (active and passive) achieve quicker recovery of motion than static immobilisation but the long-term outcome appears similar. Given the comparable outcomes between dynamic splinting and EAM, we therefore favour EAM which is simpler and more convenient.

Static Progressive and Dynamic Splinting for Wrist and Elbow

Objective: As the number of recent publications show, mobilization splinting of wrist and elbow throws a challenge to hand therapists. The number of existing designs is confusing. The purpose of this study is to present a simple and efficient solution to improve ROM based on revisited metal frame, easy to custom make, “lively splint” technology. Biomechanics: All movements are diagonal and spiral in character due to joint anatomy and diagonal orientation. For instance, dart throwing motion starting from wrist extension, radial deviation, and supination leads the wrist into flexion, ulnar deviation, and pronation. Elbow extension brings the forearm from a flexed and varus position to extension and valgus. During flexion and extension, physiological joint axis move. Full finger, wrist, and elbow flexion shortens the anterior anatomical structures while lengthening the posterior one and reciprocally for extension. Fixed axis hinged splints cannot follow the physiological joint axis displacement nor can shorten or lengthen to accommodate anatomical modifications. Fixed axis hinged splint cannot allow full flexion and extension and actually prevent it. Joints and soft tissues have to adapt to the 1-plane movement allowed by fixed axis splints, because these splints do not adapt to physiological movement. Materials and Methods: After the work of Capener and Whynn Parry, metal frame splints also known as “lively splints” were very popular in the 1950s and 1960s. With the advent of thermoplastic, they fell somehow in disgrace. However, modernized by adding proximal and distal cuffs swiveling on the frame, counter pressure cuff made of conforming material like leather to exert a perpendicular force whatever the limb position, the concept of metal frame acting as a “chassis” as well as a “motor” located on either side of the anatomical segment represent the ultimate low profile and are user’s friendly. They allow diagonal movements and some rotation and can follow the shortening or lengthening of anatomical structures during flexion and extension. They act as a 3-point splint, as a double lever of the second order, the most efficient mode of improving ROM. According to Paul Brand’s work, serial static splinting is the most efficient technique followed by progressive static splinting. However, serial static splinting using plaster of Paris or thermoplastic is time consuming since it requires at each increase in range of motion making a new cast or reheating and remodeling the thermoplastic splint. Conclusions: Metal frame splinting can act either on the progressive static or dynamic mode if coils are built into the frame. They are made once for all and are easy and fast to adjust. Thanks to adapted tools they are also easy to make and inexpensive.

Longitudinal Outcomes Following a Randomized Controlled Trial of Dynamic Splint Stretching for Carpal Tunnel Syndrome

Background: The incidence of carpal tunnel syndrome (CTS) is 48 million patients in the United States. The purpose of this longitudinal study was to determine whether Dynasplint stretching (immediately after diagnosis) had an effect on a patient's decision to seek surgical treatment for CTS. Methods: Fifty patients (10 men, 40 women, mean age 51.2 ± 12 years) were recruited for this randomized, controlled, longitudinal trial. Patients were diagnosed with CTS by physical examination and nerve conduction studies. The intervention used was Dynasplint stretching that delivered a prolonged duration of low load stretching. Patients who were randomly chosen for the Experimental category wore the device for two 30-minute sessions per day with regular increases in splint tension for 60 days. Control patients received nonsteroidal anti-inflammatory medication plus instructions on daily home stretching. Results: The final, longitudinal outcome showed a 72% reduction in surgery chosen by the experimental group (n = 25), compared with 38% reduction for control patients (n = 25). Conclusions: Immediate treatment with Dynasplint stretching showed a 2 to 1 reduction in surgery, with abundant financial savings.

Collagenase clostridium histolyticum in Dupuytren's contracture: a systematic review.

In the last few years, the use of collagenase clostridium histolyticum for management of Dupuytren's contracture has increased. The procedure of enzymatic fasciectomy has become popular because it is non-invasive, safe and fast to perform. A systematic search was performed on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'Dupuytren collagenase' and 'Dupuytren clostridium histolyticum'. Forty-three studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. The use of collagenase clostridium histolyticum provides better outcomes in patients with mild-moderate joint contracture, with lower complications and side effects than open fasciectomy. Manipulation can be performed 2-7 days after the injection. The use of collagenase is cost-effective. Most of the studies did not report patient-related outcomes. The role of dynamic splint has to be investigated with randomized clinical trials. The shorter recovery time and the low incidence of serious or major adverse effects are the main advantages of this new technology. There is a need to perform studies with longer follow-up because the recurrence rate seems to increase with time. Further investigations are necessary to assess whether it is safe and effective to inject two or more cords at the same time.

Metal frame mobilisation orthoses for wrist and elbow

1.1 Dynamic – static оrthoses/splints The terms dynamic and static are often used in splint classifications. This terminology leads to confusion. Immobilization and mobilization splints are more appropriate terms. [1], Dynamic splints are often considered to be used for improving range of motion (ROM), however static splints by maintaining a joint in end range are also efficient in increasing ROM. 1.2 This chapter presents the orthoses we recommend. At wrist level to: Increase ROM; Improve hand function in radial palsy. At forearm level to: Increase pro-supination. At elbow level to: Increase ROM.

The effect of new dynamic splint in pinch strength in De Quervain syndrome: a comparative study

Objective For patients with De Quervain syndrome using thumb spica orthosis is restricting, so many patient are dissatisfied with using static model. The aim of this study is to compare the effect of modified dynamic and conventional static orthoses on pinch power and functional abilities of hand in De Quervain syndrome. Method In this quasi-experimental study, palmar and lateral pinch strength of the thumb, pain and functional abilities of hand, patient’s satisfaction of orthoses, were evaluated after using modified dynamic and conventional static orthosis in two groups. Results Both orthoses improved palmar and lateral pinch strength of the thumb, pain level and functional abilities. In comparison of mentioned variables, there was no significant difference between two groups regarding to pain recovery and abilities improvement (p > 0.05). However, the satisfaction level of the patients who had used dynamic orthosis was higher (p < 0.05). Conclusion It seems, adding a joint to the static thumb spica leads to patient’s relief and consequently to their satisfaction.Implications for RehabilitationThe dynamic thumb spica, is easier to use and patients satisfaction is higher than static thumb spica.Therefore, it can be used for conservative treatment of De Quervain syndrome.

Silfverskiold technique combined with dynamic splinting for treatment of digital extensor tendon rupture in zones III and IV

Objective To investigate the clinical results of Silfverskiold suture combined with dynamic splinting in treating extensor digitorum tendon rupture in zones Ⅲ and Ⅳ. Methods Between March 2010 and October 2013, a total of 67 patients with 85 extensor digitorum tendon lacerations in zones Ⅲ and Ⅳ were included in this study. The tendons were repaired using Silfverskiold technique which was a combination of modified Kessler core suture and running cross-stitch epitendinous suture. The patients began controlled exercise within seven days postoperatively wearing a dynamic extension splint. Active flexion and passive extension of the fingers were repeated ten times per hour. After three weeks, the dynamic splint was removed and the patients began active finger flexion and extension. Protective static splinting was continued with the interphalangeal joints in full extension between exercises and during the night for another 2 weeks. Results Postoperative follow-up period ranged from 3 to 6 months, with an average of 4 months. Forty-two of the 67 patients regained full range of motion within 9 weeks postoperatively. At the final follow-up evaluation, according to Miller′s criteria, the results were graded as excellent in 50 fingers, good in 30 fingers and fair in 5 fingers. The overall satisfactory rate was 94.1%. There was no rupture of the repaired tendons. Conclusion Silfverskiold suture combined with dynamic splinting is an effective treatment method for extensor digitorum tendon lacerations in zones Ⅲ and Ⅳ. It is safe and reliable. Key words: Tendon injuries; Rehabilitation; Silfverskiold technique; Dynamic splinting

Effects on Upper-Limb Function with Dynamic and Static Orthosis Use for Radial Nerve Injury: A Randomized Trial

The management of radial nerve palsy associated with humerus’s shaft fractures has been discussed for several decades, instead, is the most common nerve complication after humeral shaft fracture. Indeed, radial nerve palsy recovery rate ranges from 70 to 90%, many reports related to the use of dynamic orthosis options are described in the literature. The purpose of this study is to determinate which orthosis or splint is the best option to improve patient’s upper limb function, measured with DASH (Disability arm shoulder and hand) questionnaire when surgical intervention is not indicated. Final sample size consisted of 18 participants (14 men and 4 women) with an average age of 46 who suffered from a radial nerve lesion in the dominant arm after humerus’s shaft fractures were included in the study. Participants were randomized into 2 equal groups (9 patients for the static orthosis or splint group and 9 for the dynamic orthosis/splint group). The variance analysis showed a main effect in time lapse (F (1, 58) = 71, P<0.001) indicating a significant improvement in function. Results were significantly better for the static orthosis/splint group than for the dynamic splint group. Treatment with static orthosis produces further improvement in function compared to the treatment with dynamic orthosis.

Clinical response of dynamic splint using functional scales for the extension contracture of the metacarpophalangeal joint

Clinical response of dynamic splint using functional scales for the extension contracture of the metacarpophalangeal joint