Serial Splinting Research Articles

A Look Back: A Single Surgeon's Experience Using Virtual Surgical Planning in Adult Orthognathic Surgery.

The evolution of virtual surgical planning (VSP) in the last 2 decades has led to improved precision and efficiency for orthognathic surgery, both pre- and intraoperatively. This study evaluates a single surgeon's experience with this technology over the past 6 years. Patients undergoing orthognathic surgery using VSP with the senior author between 2015 and 2021 were retrospectively reviewed. Virtual surgical planning -specific data including incidence of midline/cant correction, occlusal equilibration, serial splints, segmental osteotomies, and custom plates were recorded and analyzed. Sixty patients undergoing orthognathic surgery using simulated VSP in the study period were retrospectively reviewed. Mean age at time of surgery was 23.5±7.9 years. Forty-nine patients (81.7%) underwent LeFort I osteotomy combined with at least 1 additional procedure (eg,unilateral or bilateral sagittal split osteotomy, condylectomy, genioplasty, etc.). Twenty-six (43.3%) of patients in the studied cohort underwent maxillary midline correction, 30.0% required occlusal equilibration, 36.7% underwent maxillary molar cant correction, 30.0% underwent mandibular cant correction, and 21.7% required both maxillary and mandibular cant correction. Three patients required serial splinting, and 15 patients (25.0%) required modification of splint design. Custom plates were utilized in 15 patients (25.0%). This study demonstrates the utility of VSP in accurately detecting occlusal cants, asymmetry, and occlusal interferences. Virtual surgical planning also allows for a dynamic preoperative planning process, offering the surgeon a high degree of versatility in splint design, and the ability to fabricate multiple customized splints for each case. This is particularly useful in patients with limited or unpredictable soft tissue elasticity.

Aggressive paediatric camptodactyly: The evolution of a proposed treatment algorithm

It is a long-established teaching to avoid operating on camptodactyly unless there is a failure of non-operative treatment, such as serial splinting and hand therapy, and there is an established proximal interphalangeal joint (PIPJ) contracture of 60°; a recent systematic review reflects this continuing approach, with some papers advocating intervention with a lesser degree of contracture. To evaluate whether early flexor digitorum superficialis (FDS) release, followed by gentle passive manipulation (GPM), will correct severe 'congenital' camptodactyly, if undertaken at an earlier age than usual, thus avoiding the more aggressive surgical approach required in the established adolescent cases. The surgical technique and treatment algorithm are described. A multi-centre case series is presented; data analysis included patient demographics, syndromic association, side/digit affected, ages at onset, progression, referral and at surgery, operation details, pre- and post-operative contracture and range of motion. There were 12 patients (3 males, 9 females) who underwent 15 operations for 24 involved digits. Patients had surgery by 3 months (median) post-referral, and there was a significant improvement in median (range) PIPJ contracture (90°(30°-90°) vs. 0°(0°-45°); p<0.001) and range of motion (0°(0°-60°) vs. 90°(50°-95°); p<0.001), at a median post-operative follow-up of 2.5 years. According to the Siegert grade, 87.5% of digits had excellent/good post-operative outcomes and 12.5% had fair outcomes. This paper specifically addresses the problem of aggressive and progressive camptodactyly in the young child. By this, we mean patients who have failed non-operative treatment and have PIPJ contractures ≥60°, and those whose contractures have increased by 30° within 1 year. All cases responded to early FDS release and GPM, hence correcting the PIPJ contracture. However, cases with multiple digital involvement, whether syndromic or not, and failed previous surgery or the older child, required additional procedures to restore a dynamic dorsal apparatus and active extension.

Surgical Correction of Popliteal Pterygium with Serial Splinting: A Case Report and Review of Literature

Summary:Popliteal pterygium syndrome is an extremely rare congenital disorder, with only a few cases reported in the literature. It consists of facial, genitourinary, and musculoskeletal anomalies. A very striking characteristic of this syndrome is the popliteal pterygium contracture, which is considered the most challenging malformation to be corrected. Hence, we report a case of popliteal pterygium contracture in a 30-month-old female child with no family history of popliteal pterygium syndrome. The child was treated successfully with satisfactory results, by combining surgical intervention with postoperative serial splinting. We discuss here the tips and tricks of the surgical approach we performed, which was followed by serial splinting and physiotherapy. In addition, a literature-based review was performed providing a summary of all relevant reported cases.

Role of serial splinting in postburn contracture- Revisited

Role of serial splinting in postburn contracture- Revisited

Rehabilitation in congenital muscular torticollis operated with Z-plasty: A case report

Among the musculoskeletal congenital anomalies, congenital muscular torticollis (CMT) is the third most common. This condition presents with fibrosis of sternocleidomastoid muscle with increased lateral flexion on the same side and rotation on the opposite side. The objectives of the study were to reduce cervical deformity, mild facial asymmetry and to improve the range of motion of cervical lateral flexion and rotation. A 5-year-old female child had right torticollis for which she underwent Z-plasty. Evaluations were done on preoperative, postoperative day 1, 1 month, 4 months, and 7 months. Rehabilitation techniques included gradual stretching of the sternocleidomastoid muscle, splintage (static serial), positioning techniques, and play activities. Outcome measures observed were significant improvement in the posture of head tilt, range of motion using cervical goniometer, and facial asymmetry using photographs. This case report describes the importance of multidisciplinary treatment approach involving surgery, exercise therapy, play, and customized static serial splinting in the rehabilitation of CMT.

One-year follow-up study of serial orthotic treatment in two cases with arthrogrypotic syndromes who have bilateral knee flexion contractures.

The aim of this pilot study was to investigate the effectiveness of serial splinting in two children with bilateral knee flexion contractures due to arthrogrypotic syndrome. We evaluated the infants' passive knee extension limitation and motor development levels. Serial orthotic treatment was applied to decrease bilateral knee flexion contractures in the knees of the subjects. The follow-up period was up to 1 year. At the end of serial orthotic treatment, improvement in bilateral passive extension limitation (for the first case, the increase in passive range of extension was approximately 75°, for the second case it was 45°) was achieved in both cases. We believe that serial orthotic intervention is effective in patients with arthrogrypotic syndrome at the preoperative period or in patients who cannot be operated on. Further studies are needed for evaluation of effectiveness of this method. Our pilot study aimed to investigate the effectiveness of serial orthotic treatment in knee contractures due to arthrogrypotic syndrome in two infants which showed an improvement in range of extension.

Anterior Release of Elbow Flexion Contractures in Children With Obstetrical Brachial Plexus Lesions

A flexion contracture of the elbow is common in upper obstetric brachial plexus palsy. One less than 30° involves no major aesthetic or functional abnormalities, whereas for one greater than 30°, conservative treatment with serial splints produces variable results. We evaluated anterior release of the elbow with partial tenotomy of the anterior brachialis muscle and of the biceps, for their effect on elbow flexion contractures. We performed 10 anterior releases of the elbow with lengthening of the distal tendons of the biceps and the anterior brachialis muscle. All patients had upper obstetric brachial plexus palsies (C5-C6) and elbow flexion contractures of 35° or greater (range, 35° to 60°). The flexion strength of the elbow was 4 or higher on the British Medical Research Council scale, and the patients had no bone abnormalities in the elbow region. After a mean follow-up period of 3 years, the mean gain in extension was 28° (range, 20° to 35°). All patients maintained flexion strength. Elbow extension was 2° less than obtained at surgery and was maintained during follow-up. All patients were satisfied or very satisfied, and none presented major complications, except hypertrophic scarring to a greater or lesser extent at the incision site. Anterior release of the elbow is a useful method for treating elbow flexion contractures of more than 35° and can reduce the deformity to bring it within functional range without compromising flexion. Therapeutic IV.

Surgery combined with continuing post operative stretching and management for knee flexion contractures in cases of multiple sclerosis - a report of six cases

Contractures are a common complication of advanced multiple sclerosis. In consequence the care load is increased. Sitting in the wheelchair becomes difficult if not impossible and there is a high risk of pressure sores due to inadequate weight distribution. The greatest impedance to care and maintenance was thought to be the bilateral knee flexion contractures and unilateral hip adduction contracture frequently found in the severely paralysed MS patient. It was postulated that release of contracture would ease the care load and management. Comfort and quality of life would improve as a result. Surgery to release the bilateral knee flexion contracture was combined with passive stretching to associated contractures in an attempt to improve the physical condition. A routine regimen of maintenance was introduced postoperatively and continued indefinitely. A comparison of postoperative method to increase range using continuous passive motion (CPM) and plaster of Paris (POP) serial splinting was carried out. The results of the six reported cases show a markedly increased range of movement at the knee, a reduction in care load and an improved sitting posture postoperatively which was maintained when reassessed at nine months. Little difference between the postoperative regimens of CPM and POP fixation was found.

Kirner's deformity: A review of the literature and case presentation

Kirner's deformity is a relatively uncommon condition involving fingers in young children. A case of a 12-year-old girl who was successfully treated by serial splinting of the involved fingers is described and contrasted with other treatments described in the literature.

Passive Motion Therapy for Infants with Arthrogryposis

A comprehensive program for treatment of arthrogryposis multiplex congenita has been developed based on experiences with 95 infants and young children with arthrogrypotic deformities. The regimen emphasizes early passive stretching and serial splinting to improve joint motion. Ninety percent of the patients had contractures of all extremities; 40% had multiple congenital anomalies. Daily intensive passive stretching of joints and serial splinting have substantially increased patient function in this population. Surgical procedures have been used only in cases in which persistent deformities require correction.

Book Review: Serial Splinting in Hemiplegic Cerebral Palsy

Book Review: Serial Splinting in Hemiplegic Cerebral Palsy

Treatment and prognosis in congenital club foot.

One hundred and twenty-nine unselected club feet were classified at birth into three grades of severity; 123 were followed up. The results of primary treatment were analysed and it is shown that the bad feet did worst. Serial splinting in plasters achieved lasting correction in nine in ten mild club feet, in half of the moderately deformed, but in only one in ten of the severely affected. Surgical correction succeeded in two out of three of the resistant feet, but had to be repeated in the others.