Dynamic splinting in wrist extension following distal radius fractures

Abstract

BackgroundWrist flexion contracture is a common pathology which presents secondary to distal radius fractures. Joint stability, restoration and early mobilization are frequently achieved through surgical treatment after such an injury. The purpose of this retrospective study was to evaluate the initial effect of dynamic splinting on wrist extension (active range of motion), in both surgical and non-surgical patients following distal radius fractures.Methods Records were obtained from 133 patients who were treated with a Wrist Extension Dynasplint (WED) following distal radius fractures, between May 2007 and May 2009. Forty-two of these patients received surgical treatment for their fractures. This study specifically examined the initial usage of the WED as a home therapy. The retrospective analysis included categorization of patients who received the WED exclusively vs. patients who received WED treatment with concurrent hand therapy; surgical categorization included surgical patients vs. nonsurgical patients.ResultsThere was a significant improvement in maximal active range of motion (AROM) for all patients (P < 0.0001) after a mean duration of 3.9 weeks of dynamic splinting. Patients showed a mean 62% increase in active extension. There was not a significant difference between patients who had received surgical treatment for the fracture vs. nonsurgical.ConclusionThis dynamic splinting modality contributed 138 to 185 hours of stretching at the end range of motion for these patients in their first month following fracture. This unique regime is considered directly responsible for significant gains in AROM.

Chronic Ankle Contracture Reduced: A case series

“…8 Moreover, evidence from previous studies on dynamic splinting show empirical efficacy in prolonged duration of stretching at end-range stretching. [9][10][11][12][13][14][15][16][17][18][19][20] More specifically, these benefits compare favorably with Lai, et al, who observed neurological patients with chronic contracture 14 , as well as the observations made in this case series.…”

“…Stretching protocols for contracture have been documented as effective in reduction and it is suggested that the total duration of time at end-range of motion is the integral variable for the greatest success. 8,9,11,12 Mosely, et al, tested passive stretching, but their total durations of stretching in the four week study were 2.8 hours (short duration group stretching 6 min/day) and 15 hours (long duration stretching 30 minutes per day). 2 This supports the evidence that "prolonged passive stretching" (6-8 continuous hours) is required for contracture reduction.…”

“…2 This supports the evidence that "prolonged passive stretching" (6-8 continuous hours) is required for contracture reduction. [8][9][10][11][12][13][14][16][17][18][19][20][21] The patients in this case series achieved a mean 784 hours of end-range stretching in four months. Therefore, 196 hours of end-range stretching in the first month accounts for the different findings.…”

“…This findings is also supported in recent studies on low torque, prolonged end-range stretching have shown efficacy in contracture reduction in the jaw, shoulder, elbow, carpal tunnel, knee, ankle, foot, and toe. [9][10][11][12][13][14][15][16][17][18][19][20] One example of this protocol is in the treatment of plantar fasciopathy with prolonged stretching in dorsiflexion. Plantar fasciopathy, also known a plantar fasciitis is a common problem worldwide and can be attributed to contracture of the plantar fascia.…”

“…The "longer duration" in this study however, was only 7% of the "Prolonged Durations" of passive stretching shown effective in numerous studies that employed low torque and prolonged stretching. [8][9][10][11][12] The premise behind the protocol of dynamic splinting is that greater durations at end-range (of motion) will elongate the connective tissue with hypothetical realignment of elastin polypeptide bonds on collagen trihedral structures. 8,10,15 A study in contracture reduction compared high versus.…”