Static Splinting Research Articles

Effectiveness of static splinting in Dupuytren's disease

Effectiveness of static splinting in Dupuytren's disease

Outcomes of early active mobilization after surgical repair of injured extensor tendon of hand and forearm

Background: Extensor tendon injuries in the hand and forearm, if left untreated, can significantly impair backhand function. Timely and effective treatment is crucial. Recent evidence suggests that early active mobilization post-surgery yields better short-term outcomes, with less disparity in long-term results. Methods: This prospective observational study was conducted at the department of orthopedic surgery, BSMMU, Dhaka, Bangladesh, from March 2014 to August 2016, with a total of 40 patients. Results: The study evaluated the efficacy of early active mobilization following surgical repair of extensor tendon injuries in zones V-VIII of the hand and forearm. At 12 weeks post-surgery, 75% of patients reported no pain, increasing to 90% at 6 months and stabilizing at 85% by 12 months. Furthermore, 75% of patients regained a range of motion greater than 120 degrees at 6 months, with 60% maintaining this at 12 months. Notably, 90% of the patients maintained normal grip strength at both 6 and 12 months. Final assessments using the Mayo wrist score showed satisfactory outcomes for 70% of patients at 12 weeks, 90% at 6 months, and 95% at 12 months. The Dargan criteria echoed these positive results, with satisfaction rates of 80% at 12 weeks, 90% at 6 months, and 95% at 12 months. Complications were minimal, including superficial skin infections (5%), hypertrophic scars (10%), and tendon rupture (5%). Conclusions: The study concludes that early active mobilization, complemented by a simple static splint, facilitates faster recovery, full range of motion, improved grip strength, and earlier return to work in the early postoperative period.

Relative motion splint versus static splint in extensor tendon repair: comparative study

Relative motion splint versus static splint in extensor tendon repair: comparative study

Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age.

Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age.

UYKU BRUKSİZMİ OLAN MİYOFASYAL TEMPOROMANDİBULAR DİSFONKSİYON TANILI HASTALARDA MANUEL TEDAVİ İLE SPLİNT TEDAVİSİNİN KARŞILAŞTIRILMASI

Purpose: The aim of this study was to examine the effect of manual therapy on temporomandibular pain, range of motion, functionality level of the jaw, sleep quality, and patient satisfaction, and to compare the efficacy with splint therapy among female patients with myofascial temporomandibular dysfunction (M-TMD) accompanied by sleep bruxism (SB). Methods: A total of 29 female patients, aged 18-50 years, diagnosed with M-TMD were separated into two groups using a simple random sampling method as the manual therapy group (MT; n:15) and the splint therapy group (ST; n:14). All the patients were informed about bruxism and its effects and were given home exercises. The patients in the ST group were instructed to use a static splint for one month. The MT group patients received a total of 8 sessions, 45 minutes twice a week of treatment, including joint and soft tissue mobilizations to the temporomandibular joint (TMJ) and cervical region. Pain severity, symptoms, TMJ range of motion, jaw functionality, sleep quality, and patient satisfaction were evaluated. The evaluations were repeated after 4 weeks and compared with baseline values. Results: A statistically significant difference was determined in both groups in pain, TMJ range of motion, and sleep quality (p<0.05). In the comparison between the groups after treatment, the pain, TMJ range of motion values, and sleep quality were seen to be statistically significantly better in the MT group (p<0.05). The patient satisfaction measurements of mean general satisfaction, interpersonal attitude, mean healthcare services score, and general satisfaction total points were found to be statistically significant in the MT group (p<0.05). Conclusion: The applications of both MT and ST were seen to be effective in patients with M-TMD with bruxism. In the comparisons between the groups, the MT method was seen to be more effective than ST. It can be thought that the application of stabilization splint therapy together with manual therapy would significantly increase the treatment efficacy in patients with M-TMD.

Hand Splint: A Review

Abstract: A splint is a device consisting of bone, wood, metal, polymers, composites, or plaster of Paris that is used to stabilise, join, or protect a damaged body part. It may be movable or immovable. There are numerous methods of rehabilitation currently in use, but we are going to specifically study hand splints with their definition, advantages, disadvantages, uses, etc. in this review paper. We are also going to review the literature that is available in bibliographic databases and compare their findings. The search for these splints was conducted through bibliographic databases and internet searches until May 2022. These searches were also backed by scanning their references one by one, personal reference collections, and talking to physiotherapists. All static splints used in this review paper have been shown to be effective in reducing pain during any motion as well as at rest.

Multimodal conservative management of arthrofibrosis after total knee arthroplasty compared to manipulation under anesthesia: a feasibility study with retrospective cohort comparison

BackgroundThe ideal treatment of early-stage arthrofibrosis after total knee arthroplasty is unclear. The purpose of this study was to determine the treatment effect, including variability, and feasibility of a multimodal physical therapy program as compared to manipulation under anesthesia.MethodsThis was a prospective feasibility study with a retrospective cohort comparison. Ten consecutive patients (aged 64 ± 9 years, 7 females) with early-stage arthrofibrosis were enrolled 6 weeks after primary total knee arthroplasty and participated in the multimodal physical therapy program. The multimodal physical therapy program consisted of manual therapy, therapeutic exercise, and static progressive splinting delivered over 4 weeks. The outcomes included knee range of motion (ROM), adherence, patient satisfaction, and safety. Data were compared to a retrospective cohort of 31 patients with arthrofibrosis (aged 65 ± 9 years, 20 females) who underwent manipulation under anesthesia followed by physical therapy.ResultsOverall, knee ROM outcomes were similar between multimodal physical therapy (110° ± 14) and manipulation under anesthesia (109° ± 11). Seven out of ten patients achieved functional ROM (≥ 110°) and avoided manipulation under anesthesia with the multimodal physical therapy program. Three out of 10 multimodal physical therapy patients required manipulation under anesthesia secondary to failure to demonstrate progress within 4 weeks of the multimodal physical therapy program. Adherence to the multimodal physical therapy program was 87 ± 9%. The median patient satisfaction with the multimodal physical therapy program was “very satisfied.” Safety concerns were minimal.ConclusionThe use of the multimodal physical therapy program is feasible for treating early-stage arthrofibrosis after total knee arthroplasty, with 70% of patients avoiding manipulation under anesthesia. Randomized controlled trials are needed to determine the efficacy of the multimodal physical therapy program and to determine the optimal patient selection for the multimodal physical therapy program versus manipulation under anesthesia.Trial registrationClinicalTrials.gov, NCT04837872.

Update on the Practice of Splinting During Acute Burn Admission From the ACT Study.

Burn scar contracture (BSC) is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in function. Despite a paucity of research addressing its efficacy, static splinting of affected joints is a common preventative practice. A survey of therapists performed 25 years ago showed a widely divergent practice of splinting during the acute burn injury. We undertook this study to determine the current practice of splinting during the index admission for burn injuries. This is a review of a subset of patients enrolled in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database. ACT was an observational multicenter study conducted from 2010 to 2013. The most commonly splinted joints (elbow, wrist, knee, and ankle) and their seven motions were included. Variables included patients' demographics, burn variables, rehabilitation treatment, and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P < .05 was significant. Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. Splinting was associated with larger burns and increased injury severity on the patient level and increased involvement with burns requiring grafting in the associated cutaneous functional unit (CFU) on the joint level. The requirement for skin grafting in both analyses remained independently related to splinting, with requirement for grafting in the associated CFU increasing the odds of splinting six times (OR = 6.0, 95% CI = 3.8-9.3, P < .001). On average, splinting was initiated about a third into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50 ± 26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. The wrist was most frequently splinted joint being splinted with one third of wrists splinted (30.7%) while the knee was the least frequently splinted joint with 8.2% splinted. However, when splinted, the knee was splinted the most hours per day (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). Almost one third had splinting continued to discharge (20, 27%). The current practice of splinting, especially the initiation, hours of wear and duration of splinting following acute burn injury remains variable. Splinting is independently related to grafting, grafting in the joint CFU, larger CFU involvement and is more likely to occur around the time of surgery. A future study looking at splinting application and its outcomes is warranted.

121 25 years later: Has the Practice of Splinting Burned Joints Changed?

Abstract Introduction Burn scar contracture (BSC) across joints is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in activities of daily living (ADLs). Despite a paucity of research addressing it efficacy, static splinting of burned joints is a common preventative practice. A survey of burn centers performed 25 years ago showed a widely divergent practice of splinting. We undertook this study to determine the current practice of splinting in acute burn injuries. Methods This is a retrospective observational study of 246 patients who were included in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database from 2010–2013. The most commonly splinted joints (elbow, wrist, knee and ankle) and their 8 motions were included. Variables included patients’ demographics, burn variables, rehabilitation treatment and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P&amp;lt; 0.05 was significant. Results Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. On average splinting was initiated about a third of the way into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50±26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. Joints with higher amounts of burn involvement and need for grafting to their associated cutaneous functional units (CFU) were more likely to be splinted (p&amp;lt; 0.001). The wrist was most frequently splinted (30.7%) while the knee was the least frequently splinted joint (8.2%). The knee was splinted the longest (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). One third had splinting continued to discharge (20, 27%). The requirement for skin grafting in the associated CFU was the only factor that was independently related to splinting, increasing the odds of splinting 2% for every 1% of CFU grafted (adj OR =1.02, 95% CI=1.01–1.03, p&amp;lt; 0.001). Conclusions The current practice, especially the timing, hours of wear and duration of splinting following burns remains diverse among burn centers. Splinting is more common in joints that have more burn and deeper burns require grafting in the associated CFU; otherwise there appears to be little consensus in the practice of splinting. Future study looking at splinting application and its outcomes is warranted.

Comparing the Efficacy of Various Hand Splints in Post Stroke Recovery

Stroke is the leading cause of long-term disability in the United States, according to the CDC, and causes reduced mobility in half of all survivors age 65 and over. Additionally, most stroke survivors suffer from impaired upper extremity function, and this debilitating impairment limits persons with stroke from performing basic activities of daily living; as a result, their quality of life is reduced. Splinting seeks to aid persons with stroke in gaining critical hand function through shaping the hand properly, reducing joint pain, preventing or treating muscle contracture and spasticity, and providing assistance. While there are many splints designed for persons with stroke currently commercially available, a majority of them can be classified as part of one of two categories: static splints and dynamic splints. To examine how effective each kind of splint is at improving upper limb function after stroke, we reviewed the various designs of static and dynamic splints, their functionality, and mechanics, and summarized the study results from the literature. We also discussed both the current limitations of each design of splint, as well as designs and treatments that could be developed in the future.

Functional outcome of zone 5 to zone 8 extensor tendon injuries of hand managed with early active mobilization following repair using a static splint: an observational study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Injuries to extensor tendons of the hand are underrepresented in the literature compared to flexor tendons. The concept of early mobilization following extensor tendon repair emerged as previous strategies of static immobilization lead to frequent adhesions and poor outcome. In our study we assessed the functional outcome of early active mobilization after extensor tendon repair using a static splint. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this observational study 42 patients with 48 extensor tendon severances of the hand from zone 5 to 8 were selected. Following repair, early active mobilization with a static splint was done and the functional outcomes were assessed using the Dargan criteria. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; After mobilizing for 4 weeks, out of total 48 patients, 18 (43%) had good outcomes, 19 (45%) had fair and 5 patients (12%) had poor outcome. After 6 weeks 14 patients (33.3%) had excellent, 20 patients (48%) had good and 6 patients (14%) had fair outcomes whereas only one patient (2.4%) had poor outcome. This result was statistically significant with a p value of 0.000.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Early active mobilization following extensor tendon repair from zone 5 to 8 prevents adhesion around the repair site, leads to better post-operative outcome and faster recovery. Using a static splint along with a patient friendly, easily comprehensible rehabilitation protocol offers results comparable to the use of dynamic splints and requires fewer post-operative follow ups. The static splints being cheap, easy to construct are financially beneficial to the patients. &lt;/p&gt;

Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review.

Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords “developmental dysplasia hip”, “brace”, “harness”, “splint”, “abduction brace” to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4–5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.

Biomechanical Evaluation of Dynamic Splint Based on Pulley Rotation Design for Management of Hand Spasticity.

A dynamic splint is superior to traditional static splint, offering more benefits such as reduced spasticity, allowing comfortable stretch, repositioning fingers in extension positions, and increasing hand performance. This paper suggested the development of a dynamic splint based on a pulley rotation with a locking system as a home rehabilitation device to reduce hand spasticity in stroke patients. Moreover, this study consisted of two main activities: simulation using finite element analysis and clinical experimental trials. Eight stroke patients participated in 4 weeks of intervention using the proposed dynamic splint for a combined total of least 3 hours per day at home. Outcome measures included Fugl-Meyer Assessment (FMA) and Modified Modified Ashworth Scale (MMAS) at baseline, 2 weeks, and 4 weeks. After 4 weeks of wearing, participants were also asked to fill out a satisfaction questionnaire. The results showed that wearing this proposed dynamic splint over 4 weeks, the hand function of participants increased significantly(p < 0.05), and the spasticity of the hand muscles decreased significantly(p < 0.05). With an overall rating of 8 out of 10 points, stroke participants had a high level of satisfaction with this home-use dynamic splint. The findings indicated that stroke patients who used this proposed splint showed substantial changes in hand function and reduced hand spasticity.

The Influence of Personal and Physical Contexts on OTs’ Intervention Choices for Addressing Contractures

Abstract Date Presented 03/28/20 This quantitative cross-sectional survey design study conducted with 409 OTs investigated the influence of practice and personal context factors on the choices that OTs have in addressing upper-extremity contractures. For interventions that had a high likelihood of being used, specifically static splinting, stretching/PROM, and positioning, there were no practice context barriers found, yet it was with these interventions that there was little belief in their effectiveness. Primary Author and Speaker: Heather Thomas

Stretching and Splinting Interventions for Poststroke Spasticity, Hand Function, and Functional Tasks: A Systematic Review.

Spasticity is one of the most common and disabling motor impairments after stroke. To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity. Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017. Following PRISMA guidelines, we included articles describing Level I-III studies with participants who were adults with upper extremity spasticity and received a stretching intervention. Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria. For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.

Analyzing the functional effects of dynamic and static splints after radial nerve injury

The radial nerve is a commonly injured upper extremity peripheral nerve. The inability to extend the wrist results in a loss of hand function and dexterity that affects patients’ ability to perform their activities of daily living. There is no strong evidence to support a particular splint design for improving dexterity. This cohort study compared whether a static or dynamic splint can improve hand dexterity when assessed with the 9-hole peg test (9-HPT) after radial nerve injury. Thirty-four subjects with radial nerve palsy participated in the study. The test was repeated three times for each subject, first without the splint, and then while wearing the control static wrist splint, and finally while wearing the dynamic splint. The 9-HPT was used as the outcome measure. The 9-HPT times were 36.4±4.8seconds without a wrist splint and improved when using the static and the dynamic splints to 33.5±4.5seconds (P<0.01) and 25.7±3.5seconds (P<0.01) respectively. The use of a dynamic splint after radial nerve palsy can provide the patient with greater manual dexterity when compared to using no splint or a static splint.

838 An Economical Alternative to Static Progressive Splinting of the Elbow

Abstract Introduction A common musculoskeletal complication of burn trauma are elbow extension contractures which can have disabling effects on both daily living skills and leisure activities. One intervention which is used by Therapists to maximize active range of motion in these cases are static progressive splints. The benefit of static progressive is providing a continued gentle stretch, which is adjustable, to maximize length of connective tissues and improve joint pliability. These types of splint can be custom made or purchased commercially to the cost of the patient. Commercially provided static progressive splint are costly for the patient and are not efficient in capturing end range extension. Traditional static progressive splint patterns do not allow for the patient to provide the adjustable force rather, the therapist remodels the splint as range of motion gains are achieved. The “I” splint was created to allow for the patient to provide a static progressive low load adjustable force and range of motion while using the splint over the course of thirty minutes. Methods The splint is fabricated from therma plastic material. The standard anterior elbow extension splint pattern is made thought with a midline window. (Photo 1). When modeling the splint, the therapist positions the boarders of the splint higher than the upper extremity as this will act as the level arm for the adjustable force. Three straps are attached (photo 2). Distal at the wrist, proximal at the elbow and midline at the elbow. The elbow strap attached to the medial board, cups the posterior elbow and is fed inside the lateral board, then pulled up and over th boarder. This positioning transmits the upward force to gain extension. As the stretch decreases, the strap is pulled more tightly, allowing for increased elbow extension. The elbow comes up and through the window. Goal is for the patient to use 3 times per day for 30 minutes each session followed by exercise or functional activities which engage improved connective tissue length. Results There are many benefits from the use of the “I” splint pattern. The splint is able to be fabricated during 1 therapy session and be used immediately. The therapist only bills one orthotic charge and splint charge vs a costly rental and purchase price for the patient. The window design allows for greater adjustability of force able to capture fluctuations with stiffness and pain without fabricating another splint. The splint is lighter weight and easily portable. Conclusions The “I” splint design is a effective, efficient and economic intervention to treat elbow extension contractures. Applicability of Research to Practice Further research needs to be done to investigate range of motion gains and time to makes gains, effects on functional outcomes, cost benefits analysis with the “I” splint design for the patient and Health Care Systems.

Wrist opener splint: An effective way to treat chronic wrist flexion contracture

In Senegal, patients are seen an average of 16 months after their injury in a specialized hand and upper limb surgery department. Because of this lengthy delay, these patients have severe functional sequelae, such as wrist flexion contracture, averaging 45 degrees in our case series (range, 35 to 90 degrees). After reviewing the literature, we did not find any splint that was well suited to these patients. Inspired by the general splinting rules set out by Schultz, MacConaill and Brand, we constructed a volar/dorsal splint to reduce these contractures. We have been using this serial static splint for 2 years. We performed a prospective study of 17 wrists to evaluate its therapeutic benefit, describe its use and outline its optimal application.

Effect of Dynamo-Static Splint on Post Operative Knee Stiffness

Aim: To Study the effect of Dynamo-Static Splint on Post-operative knee stiffnessObjectives: The Objectives of the study are as follows: (1) To find the effect of Dynamo-Static Splinting onPain (2) To find the effect of Dynamo-Static Splinting on Knee Range of MotionMethods: This study was conducted for the duration of 6 months. 20 subjects of age 20 to 60 years werescreened out of which 10 subjects were selected for the study depending on the inclusive and exclusivecriteria. Condylar Fracture of Femur and Tibial Plateau Fractures referred to Physiotherapy DepartmentBetween 4 to 5 weeks. These subjects were then divided into 2 groups Pre-treatment assessment and Posttreatment assessment were recorded.Results: Statistically significant differences in the VAS at rest and activity, Pre and Post range of motionwere seen between the two groups. Post treatment Range of motion It indicated that it was significant (p &lt;0.0001) and (p = 0.0460) in the interventional group subjects. VAS at rest. It indicated that it was significant(p &lt; 0.0001) and (p = 0.0203) in the interventional group subjects. Intra group analysis of these values withinthe group was done using Wilcoxon test and the Inter group analysis between the groups was done by MannWhitney test.Conclusion: The present study provided evidence to support the use of dynamo static splint for postoperative knee joint stiffness. In addition, results supported splinting exercises were significantly effectivein reducing the quality of pain and improving range of motion in post-operative knee stiffness.

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.