Wrist Splint Research Articles

Application of Removable Wrist Splint in the Management of Distal Forearm Torus Fractures

BackgroundThere is considerable variation in the treatment of distal forearm torus fractures (DFTF), from soft bandaging to cast immobilization.ObjectivesThe present study aimed to show the result of removable wrist splint (RWS) in the treatment of these fractures.Materials and MethodsOne hundred forty two children aged less than 17 years old with DFTF were studied prospectively. These patients were randomly treated either by a short arm cast (SAC) or a RWS for three weeks. Finally the treatment results of the two groups were compared.ResultsThere were no significant differences regarding degree of pain, compliance or complications between RWS and SAC groups. Resource savings can be made with this approach also patients’ and parents’ satisfaction can be increased without compromising patients' care.ConclusionsRWS can be considered as an easy and acceptable treatment modality with very low costs and complications in the management of DFTF.

MID-MOTION DEFORMATION OF MEDIAN NERVE DURING FINGER FLEXION: A NEW INSIGHT INTO THE DYNAMIC AETIOLOGY OF CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) exists in a spectrum of severity and symptoms with a dynamic component. We aim to study dynamic nerve-tendon interrelationships in normal and mild CTS wrists during a fist motion, with dynamic ultrasound. We observed that in normal wrists, the nerve arcs in an ulnar-volar direction and changes from a circular shape to a flat oval during motion. In CTS candidates, however, the curvature and distance of the nerve's path are reduced, while nerve shape remains relatively constant. In all candidates, the nerve is compressed against the flexor retinaculum, with the nerve subject to less compression in normal candidates as it moves dorsally into a recess. These findings suggest that besides mechanical compression from increased carpal tunnel contents alone, a decrease in nerve gliding movement may lead to CTS symptomatology. Furthermore, we identified that maximum nerve deformation occurs mid-motion, supporting the use of wrist splints for symptom relief.

Functional outcome of flexor tendon repair of the hand at Zone 5 and post operative early mobilization of the fingers

Objective : There are few reports on outcome following flexor tendon repair of the hand in zone 5. We hypothesized that early mobilization of the fingers is possible if the suture site of repaired tendon is strong enough. The aim of this study was to assess the results of flexor tendon repair in this zone using modified Kessler method reinforced by peripheral running suture and a post operative early active and passive mobilization of the fingers. Methodology: This prospective study was carried out between April 2006 and Feb 2010, and 171 digits flexor tendons cut in 42 patients were repaired by modified Kessler technique reinforced by running peripheral suture. Early active mobilization and gentle passive motion of the fingers was allowed in a dorsal wrist splint the day after surgery. Wrist Immobilization was performed for one month. Function of the tendons was assessed by Buck-Gramcko score at nine month follow up. Results: Mean age of the patients was 25.4 years (range 17-46 y). Twenty nine flexor policis longus, 77 flexor digitorum superficialis and 65 flexor digitorum profundus tendons of digits were repaired. Middle and index fingers were most commonly involved. Median and ulnar nerve repair was done in 17 and 12 cases respectively. Good to excellent results were seen in of 79.34% of FPL and 74.65% of other finger flexors. One case of FPL rupture was seen. Tenolysis of FDS was performed in one case. Recovery in thenar muscle function was good, fair and poor in 5, 2 and 10 cases after median nerve repair, while all 12 patients with ulnar nerve lesion showed some degrees of clawing of 4th and 5th fingers. Conclusion : Most patients following flexor tendon repair at zone 5 obtained good results. Early motion of the fingers seems to improve outcome in these patients. Concomitant nerve cut in particular of ulnar nerve were associated with a high rate of poor results.

Kinematics variations after spring-assisted orthosis training in persons with stroke

Static wrist splinting after stroke was not effective in facilitating distal movement. However, the purpose of this study is to evaluate the efficacy of training using kinematic parameters after a SaeboFlex orthosis training on chronic stroke patients. Five stroke patients participated in 4 weeks of training using a SaeboFlex orthosis for 1 hour per day, five times per week. Fugl-Meyer Assessment, Box and Block Test, Action Research Arm Test, and Kinematics using a three-dimensional motion analysis system were used for evaluating of training effects. The upper extremity score of the Fugl-Meyer Assessment and the Box and Block Test score were increased significantly after the intervention. The jerkiness score of the shoulder and elbow joints at the sagittal plane decreased significantly during the reach-to-grasp task at acromion height, and the jerkiness scores of the wrist joint during the reach-to-grasp task decreased significantly at both elbow and acromion heights. The results of this study indicate that a SaeboFlex training is effective in recovering the movement of the hemiparetic upper extremity of patients after stroke. Using a spring-assisted dynamic hand orthosis is considered to be an effective treatment option for providing repetition, task-oriented training, and real-world activities for the hemiparetic upper extremity, which was impaired hand to perform functional training.

Newer challenges to restore hemiparetic upper extremity after stroke: HANDS therapy and BMI neurorehabilitation

Abstract Because recovery of upper extremity (UE) functions to a practical level has been considered difficult in many patients with stroke, compensatory approaches have been emphasised. Recently, based on basic and clinical research indicating a greater potential for plastic changes in the brain, approaches directed toward functional restoration are becoming increasingly popular. Meta-analysis has indicated the effectiveness of constraint-induced movement therapy, electromyography biofeedback, electrostimulation, mental practice, and robot exercise to improve UE functions, but not hand functions. Therefore, we devised two new interventions to improve the paretic hand. One is hybrid assistive neuromuscular dynamic stimulation therapy, designed to facilitate daily use of the hemiparetic UE by combining electromyography (EMG)-triggered electrical stimulation with a wrist splint. We demonstrated improvement of motor function, spasticity, functional scores, and neurophysiologic parameters in chronic hemiparetic stroke. With a randomised controlled trial, we also demonstrated its effectiveness in subacute stroke. The other is brain-machine interface neurofeedback training, which provides real-time feedback based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extension of the affected fingers. This elicited new voluntary EMG activities, and improved finger functions and neurophysiological parameters. These interventions may offer powerful neurorehabilitative tools for improving hemiparetic UE function after stroke.

Changes in the carpal tunnel while wearing the Manu® soft hand brace: a sonographic study

We studied the effect of the Manu(®) soft hand brace, which has been designed to relieve median nerve entrapment in carpal tunnel syndrome. An observational, controlled study was conducted in 10 participants, five with bilateral carpal tunnel syndrome and five controls, using sonography to study changes in the dimensions of the carpal tunnel before and while wearing the brace. An increase in transverse diameter, thinning of the flexor retinaculum, and displacement of the proximal insertion of the lumbrical muscle to the middle finger from the edge of the carpal tunnel were observed in patients while wearing the brace. The changes in the morphology of the carpal tunnel while wearing the Manu(®) support its use as an alternative to a night wrist splint.

Isolated volar dislocation of distal radioulnar joint: rarely occurring, commonly missed

IntroductionDistal radioulnar joint dislocations with associated fractures,such as Galeazzi fracture or distal radius fracture, are com-mon injuries. However, isolated dislocation of distal radio-ulnar joint without fracture is rare and is described in termsof the position of the ulna in relation to the radiocarpal joint[1]. Dorsal dislocation is more common than volar disloca-tion [2, 3]. Because of the paucity of this injury, emergencyphysician may easily miss this injury and the deformedwristmay present to the orthopedic surgeon later. Early diagnosis,reduction,andimmobilization restore forearm rotation inthemajority of cases. Failed closed reduction and unstableDRUJ, however, requires surgical stabilization.Case reportA 16-year-old male sustained an injury to his left wrist aftera fall on outstretched hand. He came to our A&E where anemergency physician attended him. His wrist was X-rayed,and considering no bony injuries, a differential of soft tissueinjury was made. A wrist splint was applied and he wasasked to consult an orthopedic surgeon. Two days later, hepresented to our out-patient department.On examination, there was moderate swelling of the wristand marked restriction of movement. Tenderness could beelicited over ulnar styloid and DRUJ region. Careful exam-ination of the previous X-ray was suggestive of minimallydisplaced ulnar styloid fracture in the anteroposterior viewand volar dislocation of DRUJ in the lateral view [Fig. 1].The dislocation was reduced under supraclavicular blockunder an image intensifier. Radioulnar transfixation with a1.8-mm K-wire was done, as the joint was unstable [Fig. 2].Limb was immobilized in an above elbow cast. The fractureof ulnar styloid was minimally displaced and just above thebase. It assumed itsposition after relocation ofulna so it wasnot fixed. The cast as well as the K-wire was removed after6 weeks [Fig. 3]. Gradual physiotherapy regained full func-tion and movements of wrist after 4 weeks. A 1-year follow-up reduced DRUJ, leading to pain-free wrist with full rangeof movements.DiscussionCotton and Brickley [4] were the first to describe this injurypattern in cadaver. Forced hypersupination of the forearmgenerally results in volar dislocation of the ulna. Other

Comparison Efficacy of Triamcinolone and Wrist Splint in Severe Carpal Tunnel Syndrome in Pregnancy

Introduction: Carpal tunnel syndrome (CTS) is entrapment of median nerve in carpal tunnel of the wrist. The main aim of this study was to compare the effectiveness of steroid injection and wrist splint in severe carpal tunnel syndrome in pregnancy. The cases were selected among pregnant women who referred to OB and GYN clinic in Yasuj city in South- west of Iran. Materials and methods: This study is a randomized clinical trial which was accomplished from December 2010 to June 2012 at S. Mofateh Clinic on 28 pregnant women. Standard electrodiagnostic techniques were performed on the women who had clinical symptoms of CTS in their hands, with positive Tinel and/or Phalen tests, for rule in/or out of CTS. The patients with severe CTS were randomly divided in 2 groups including triamcinolone injection (40 mg) and wrist splint in night for 6 weeks. Electrophysiologic parameters of median and ulnar nerves were recorded before and 2 months after the steroid injection and wrist splint. In cases of observing changes from severe to lower stages of the disease in electrodiagnostic studies, treatment was considered successful and otherwise failed. Results: Effectiveness of triamcinolone injection and wrist splint were 85. 7% and 90. 9%, respectively. There was no significant difference between treatments by steroid injection and wrist splint (p=0. 157). Also no correlation was observed between severe carpal tunnel syndrome and number of pregnancy. Conclusion: Triamcinolone injection or wrist splint are effective methods for treatment of severe CTS in pregnancy and therefore recommended instead of carpal tunnel release surgery.

Prevalence of clinical findings of carpal tunnel syndrome in Isfahanian dentists

Background:Carpal tunnel Syndrome (CTS) is the most common compression neuropathy. Jobs with frequent and repetitive hand movements are one of the risk factors for this syndrome. The aim of this study was to determine the prevalence of CTS in Isfahanian dentists.Materials and Methods:In this cross-sectional descriptive study, 240 dentists were evaluated for CTS. Diagnosis was made according to both questionnaire and clinical tests of Phalen and Tinel. Age, sex, years of experience, working hours per week and the type of procedure were considered as dependent variables. All data were analyzed by Chi-square and T-test using SPSS software 11.5 (α=0.05).Results:Among the dentists who were studied, 173 (72%) were male and 67 (28%) were female. 16.2% of males and 17.9% of females had symptoms of CTS and there wasn’t any significant difference between them (P>0.05%). the prevalence increased with advancing age. In a way that it reached to 22.2% in ages more than 55 in contrast to 6% among individuals between 25–34 years old. With increasing of experience to 15 years the risk of CTS increased but an unexpected reduction was observed with more than 15 years of experience.Conclusion:This study showed the prevalence of CTS was 16.7% among dentists and was more common in older dentists. CTS prevalence was increased with age. The dentist population with more working hours per week and more experience years were more susceptible for this syndrome. Using suitable gloves, wrist splints and short periods of resting during vigorous continuous working can decrease the symptoms of this disease.

Treating buckle fractures in children with removable splints

Buckle fractures of the distal radius are unique to children. Immobilising the limb in a plaster cast is the traditional treatment. An alternative is to use a removable wrist splint and this has been adopted at the author's clinic. In this article, literature on the change of practice is reviewed, the change is described and the outcomes evaluated. It was found that treatment with the wrist splint was cost-effective and was preferred by children, families and carers.

The efficacy of phonophoresis on electrophysiological studies of the patients with carpal tunnel syndrome

To investigate the efficacy of phonophoresis with nonsteroid anti-inflammatory drugs (P-NSAID) and corticosteroids (P-CS) in the treatment for carpal tunnel syndrome (CTS) and to compare the efficacy of phonophoresis with local CS injection (LCSI) and splinting with a 3-month follow-up. 84 hands of 51 patients with CTS were treated by applying LCSI, P-CS, P-NSAID, and wrist splinting. Electrophysiological studies, grip strength, hand dexterity, and sensory recovery of the first three digits were assessed. Duruöz hand index (DHI) was used to assess the functional hand disability. For clinical evaluation, we used Phalen and Tinnel signs. Pain intensity was evaluated by visual analog scale. The LCIS group showed a significant improvement in pain relief and DHI, but this group had significant deterioration in the results of monofilament and pegboard tests. The P-CS group showed improvement in sensory nerve conduction velocity, distal latency, grip strength, and DHI parameters. There was a significant improvement in grip strength, pegboard test, and pain intensity in the P-NSAID group. There was improvement only in pain intensity in the splinting group. We identified marked improvement in the electrophysiological studies in the P-CS group. Splinting had no effect on hand functions, disability, and electrophysiological studies.

Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes

Firstly, we aimed to determine the effectiveness of various treatment modalities using ultrasonography (US), and secondly, we aimed to assess the correlations between the ultrasonographic findings and electrophysiological tests, symptom severity, functional status and physical findings. 74 hands of 47 patients with carpal tunnel syndrome (CTS) were randomly treated by applying wrist splinting alone in the neutral position (23 hands), phonophoresis with corticosteroid (PCS) (28 hands) and phonophoresis with non-steroid anti-inflamatory drug (PNSAI) (23 hands). The cross-sectional area (CSA) of the median nerve (MN) was determined by ultrasound on the initial and at the 3 months after treatment. MN conduction studies were performed on the initial visit and 3 months after treatment. The patients completed the Boston symptom severity questionnaire. For clinical evaluation, we used Phalen's and Tinel's signs. We could find reduction in CSA of MN in PCS group (P < 0.001). The CSA of MN was inversely correlated with motor sensory and median nerve conduction velocity (NCV) (r = 0.421, r = 0.213, respectively). Statistically significant correlations were not detected between ultrasonographic parameters and clinical evaluation parameters (P > 0.05) and also between ultrasonographic parameters and BQ scores (P > 0.05). Although there was some improvement in clinical parameters, ultrasonographic parameters did not change in P-NSAI group. The most effective treatment modality was P-CS according to ultrasonographic and other findings. Although there were inverse correlations between the CSA of MN and sensory and motor MN conduction velocity, no relationship was found between symptom severity, functional status and US findings or electrophysiological studies.

Painful numb hands

Carpal tunnel syndrome, resulting from median nerve compression at the wrist, is a common and often disabling mononeuropathy. Risk factors include female sex, family history, repetitive hand use, obesity, pregnancy and a variety of medical comorbidities including diabetes mellitus, rheumatoid arthritis, and other connective tissue diseases. In many cases, an accurate diagnosis can be reached on the basis of clinical history and supportive examination findings alone. Neurophysiological investigations are essential for confirming the diagnosis, assessing severity and excluding more generalised neuropathies, as well as providing a baseline preoperative index of median nerve function. Wrist splinting and local corticosteroid injection are effective treatments in the short term, but long-term data are lacking. Surgical (endoscopic or open) carpal tunnel release is effective and nearly always required to enable a return to work for patients with occupationally induced carpal tunnel syndrome.

Revisión sistemática: uso del brace en la epicondilalgia lateral

Lateral epicondylalgia is a fairly common clinical problem that affects both athletes and subjects performing manual tasks. Recently, the use of brace has become a routine indication in the therapeutic management of these patients. A synthesis of the evidence has been made through a systematic review of randomized controlled clinical trials. Objetive To determine whether there is scientific evidence that support the use of the brace in patients with lateral epicondylalgia. Search strategy Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) were included in the search. The databases used were MEDLINE, CINAHL, Central, EMBASE, PEDro, and LILACS. Results 5 articles were selected that met our eligibility criteria. Conclusion There is moderate evidence that the short-term brace improves the performance of activities of daily living compared with a physical therapy program and the severity of pain compared with Laser and Ultrasound. When compared with a wrist splint, MP of pain at Week 6 was 0.24 (-0.07, 0.55). Thus, there is no difference between the two interventions.

Displacement of the pisiform: a radiographic sign for synovitis of the wrist joint

Acute traumatic wrist synovitis causing volar displacement of the pisiform. The patient presented to the emergency department and was diagnosed with a dislocation of the pisiform, and her wrist was splinted. Upon examination in the hand clinic, ulnar-sided wrist pain and warmth were noted. MRI examination demonstrated an enhancing proliferation of tissue and fluid on T2, which emanated from the radiocarpal joint, displacing the pisiform volarly. The flexor carpi ulnaris tendon insertion was deemed intact. Isolated dislocations of the pisiform are rare. Traumatic synovitis of the wrist joint results from inflammatory proliferation of the synovium resulting in symptoms of pain, swelling, and restricted motion [1]. The most common noninfectious cause of traumatic wrist synovitis is overuse or trauma [2]. The 1 week delay between injury and onset of symptoms in this case is more characteristic of traumatic wrist synovitis. Traumatic wrist synovitis can also be seen in patients with underlying conditions such as rheumatoid arthritis, osteoarthritis, crystalline deposition disease (CPPD), or infection [2]. No evidence of rheumatoid arthritis or CPPD was seen on radiographs. The patient was placed in a right wrist splint and given a 6 day Medrol Dosepak. Follow up examination at 2 weeks showed complete resolution of wrist swelling, tenderness, and warmth. The pisiform triquetral joint is a synovial joint that communicates with the radiocarpal joint [3]. In this case the traumatic synovitis proliferation from the wrist joint expanded into the pisiform triquetral joint causing the displacement of the pisiform. This was demonstrated on MR by the acute angle subtended by the FCU tendon. The MRI findings as well as the clinical features of ulnar-sided wrist pain, wrist swelling, and the prompt resolution of symptoms lead to the diagnosis of acute traumatic wrist synovitis. We now consider displacement of the pisiform on conventional wrist radiographs a potential sign of acute wrist synovitis.

Effectiveness of Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy in Patients With Subacute Stroke

Background and objective. Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy was devised to facilitate the use of the hemiparetic upper extremity in daily life by combining assistive neuromuscular electrical stimulation, referred to as the integrated volitional electrical stimulator (IVES), with a splint. The aim of this study is to assess the effectiveness of HANDS therapy for patients with subacute stroke. Methods. The participants were 24 inpatients receiving rehabilitation for hemiparetic stroke within 60 days of onset. Entry criteria included inability to individuate finger extension. Patients were randomly assigned to 2 groups. The HANDS group (n = 12) used the IVES combined with a wrist splint for 8 hours a day for 3 weeks, and the control group (n = 12) wore a wrist splint alone. All patients received the same daily dose and length of standard poststroke multidisciplinary rehabilitation. Outcome measures were the upper extremity portion of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log-14 (MAL). Results. In all, 10 patients in each group completed the interventions. Compared with the control group, the HANDS group showed significantly greater gains in distal (wrist/hand) portion of the FMA (P < .01) and improvement of the ARAT (P < .05). The gains in the MAL did not differ. No adverse effects occurred and the HANDS therapy was well accepted. Conclusion. HANDS therapy in addition to conventional therapy may improve hand function in patients with moderate to severe hand impairment during early rehabilitation.

Upper Extremity Injury in a Soccer Player

HISTORY: A 32-year-old male was playing in a weekend soccer game when he was kicked in the shin by another player. His legs flipped out from under him, and he landed with his hand outstretched behind him. He had immediate pain in his wrist and felt a "burning pain" shoot up his forearm. He reported an immediate deformity and subsequent swelling. Suspecting a wrist fracture and not wishing to wait in the Emergency Department, he purchased a wrist splint at a local drug store with the plan of going to the doctor the following day. At night he had episodes of paresthesias radiating from the wrist, distally to the first three digits. He presented to the Sports Medicine office the following day reporting no further paresthesia or weakness. His history involved no prior injuries to his right wrist or hand. PHYSICAL EXAM: Examination revealed a moderately swollen wrist and hand with ecchymosis over the palmar surface of his wrist. Exam of his elbow and shoulder was unremarkable. At the wrist, he was able to initiate motion in all planes, but his range was severely limited in flexion, extension, ulnar and radial deviation, supination, and pronation. Flexion and extension caused some tingling in his first three digits. He was tender over the center of the proximal carpal row on both the dorsal and palmar surfaces. There was no snuff-box tenderness, no ulnar styloid tenderness, and no distal radial tenderness. Palpation of the "ulnar snuff box" and manipulation of the TFCC produced no pain. Radial and ulnar pulses were 2+, and his distal sensation was grossly intact. He had no motor deficits. Tinnel's test at the carpal tunnel did not reproduce the reported paresthesias. DIFFERENTIAL DIAGNOSIS: Distal radius and/or ulna fracture Carpal fracture Carpal dislocation Severe sprain Tendon rupture TESTS AND RESULTS: Three radiographic views of the affected wrist and hand were ordered (AP, Lateral, Oblique) revealing a volar dislocation of the lunate and a small ulnar styloid avulsion. No scaphoid fracture was visualized. FINAL / WORKING DIAGNOSIS: Lunate dislocation with intermittent, positional median nerve compression. TREATMENT AND OUTCOMES: The patient was placed in a splint and sent for immediate consultation with a hand surgeon. The patient was taken to surgery for open reduction of the lunate and ligamentous repair.

Wrist Pain in a Football Player

HISTORY: A 21 year old college wide receiver fell on his outstretched dominant right hand. He had immediate pain and "shifting" in his right wrist. Initially there was no swelling, but tenderness at the wrist without bony instability. He was taped and continued in the next play, but again had the same complaint. A perilunate dislocation was suspected, so traction in extension with direct pressure volarly was applied. A clunk was felt, but reduction remained uncertain, so a splint was placed and sent to the ED. PHYSICAL EXAM: Swelling along the dorsal aspect of the right hand with point tenderness along both sides. Limited active volar and dorsiflexion secondary to pain. A palpable clunk with positioning into dorsiflexion. Prominence volarly just above the wrist crease. Normal capillary refill with palpable pulses. Neurovascularly intact, normal sensation to light touch along the median nerve distribution. Decreased two-point discrimination. DIFFERENTIAL DIAGNOSIS: Lunate/Perilunate dislocation Scapholunate dissociation Scaphoid Fracture Distal Radius Fracture TESTS AND RESULTS: Radiographs, three views: Lunate dislocation volarly and medially indicating underlying ligamentous injury to the scapholunate and lunate-triquetral ligaments. No definite scaphoid fracture identified; rotational subluxation of the scaphoid, possible scapholunate ligament disruption. All other carpal bones maintained their normal relationships. FINAL WORKING DIAGNOSIS: Perilunate Dislocation TREATMENT AND OUTCOMES: An orthopedic resident attempted a closed reduction with traction under conscious sedation, but was unable to maintain a reduction. The patient developed numbness in the median nerve distribution so he was sent for urgent open reduction and internal fixation of the perilunate dislocation. Surgical Treatment: ORIF of right lunate dislocation via volar and dorsal approach Scapholunate, lunotriquetral and lunoscaphoid ligament repair with percutaneous pins along the lunotriquetral articulations and a cancellous screw within the scapholunate articulation ORIF of lunotriquetral interval Right carpal tunnel release Post-Op: Placed in a short arm volar wrist splint ROM exercises Pins left intact for 6 weeks Return in 3 months for removal of the scapholunate cannulated screw

Cost-effectiveness analysis of cast versus splint in children with acceptably angulated wrist fractures

In a practice setting where casting is considered the standard of care, the aim of this study was to assess the cost-effectiveness of wrist splints compared with routine casting in children with acceptably angulated distal radius greenstick or transverse fractures. A cost-effectiveness analysis was conducted alongside a randomized controlled trial (RCT). One hundred children with acceptably angulated distal radius greenstick or transverse fractures received either a wrist splint or cast. Information on health care provider and patient and family resource use as well as productivity cost was collected. Resource use was costed using unit costs from local administrative data sources and expense diaries. Effectiveness was assessed at 6 weeks using the performance version of the Activities Scale for Kids (ASKp) questionnaire. Cost-effectiveness analysis related differential costs to differential ASKp scores. Mean total cost was $877.58 in the splint group and $950.35 in the cast group, with a mean difference of $-72.76 (standard error [SE] 45.88). Mean total healthcare cost was $670.66 in the splint group and $768.22 in the cast group, with a mean difference of $-97.56 (SE 9.24). Mean (SE) ASKp was 92.8 in the splint group and 91.4 in the cast group, with a mean difference of 1.439 (SE 1.585). Therefore, splint management was more effective and cheaper. After accounting for uncertainty, the probability of splint being cost-effective compared with cast was 94 percent for a willingness-to-pay threshold value of $0 for one-unit gain in ASKp score and exceeded 82 percent for all threshold values. In this RCT, splint management was cost-effective compared with casting in children with acceptably angulated distal radius greenstick or transverse fractures. This study challenges the existing standard of care for children with this type of fracture and provides justification on clinical and economic grounds for a change in routine practice.

Effect of E. laciniata (L) Ointment on Mild and Moderate Carpal Tunnel Syndrome: A Double‐blind, Randomized Clinical Trial

This paper concerns the effects of methanol extract of Eremostachys laciniata on mild and moderate Carpal Tunnel Syndrome (CTS). Forty patients, including sixty hands affected by CTS, were randomly categorized in two different groups. Group A and Group B were treated with E. laciniata extract and placebo as the ointment, respectively. Tests, including the palmar prehension (pound), grip power (kg), visual analog scale (VAS) and electrodiagnostic study, were performed on all patients before and after the trial. During the trial, all patients receive Sodium Diclofenac (25 mg twice a day) orally. In addition, they utilized a night wrist splint. After four weeks of treatment, the state of mean palmer prehension in both groups improved yet, the statistics show that group A prevailed by (p = 0.01). Grip power increased in both groups as well, but this increase was not significant within-groups (p = 0.18 and p = 0.54 in group A and B, respectively) or between-groups (p = 0.053). Although the VSA decreased in both groups, group A prevailed again by (p < 0.001). After four weeks, no significant electrodiagnostic change was detected between the two groups. According to this study, the methanol extract of E. laciniata can be effective in treatment of mild and moderate CTS in combination with the wrist night splint, especially in alleviating the severity of the syndrome and increasing the palmer prehension power.