Night-Time Splinting After Fasciectomy or Dermo-Fasciectomy for Dupuytren’s Contracture: A Pragmatic, Multi Centre, Randomised Controlled Trial
By Jerosch-Herold, Christina; Shepstone, Lee; Chojnowski, Adrian J.; Larson, Debbie; Barrett, Elisabeth; Vaughan, Susan P.; BMC Musculoskeletal Disorders, Vol. 12, No. 136Publication Date: June 21, 2011
Study evaluated the effect of night splinting on self-reported function, finger extension, and satisfaction in patients undergoing fasciectomy or dermofasciectomy as treatment for Dupuytren’s contracture. Dupuytren’s disease (DD) is defined as a progressive fibroproliferative disorder which can result in fixed flexion contractures of the fingers and impaired hand function. Standard surgical treatment involves surgical release or excision (fasciectomy) followed by postoperative hand therapy and splinting. Long term recurrence may be reduced by excision of cords and nodules with the overlying skin and skin grafting (dermo-fasciectomy). Study participants were 154 DD patients from 5 regional hospitals who were randomized after surgery to receive hand therapy only or hand therapy with night splinting. Patients in the splint group received a custom made thermoplastic splint designed to accommodate the operated rays of the hand with the metacarpophalangeal and/or proximal interphalangeal joint held in maximum extension without causing tension to the wound. Primary outcome was self-reported function using the 30 item Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. At 12 months, 148 patients completed follow-up. No statistically significant differences were observed on the DASH questionnaire, total extension deficit of operated digits, or patient satisfaction. In a secondary per protocol analysis, no statistically significant differences were observed between the groups in any of the outcomes. The authors conclude that, given the added expense of therapists’ time, thermoplastic materials, and the potential inconvenience to patients having to wear the device, routine night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits occur.
Published by: BioMed Central Ltd (Website:http://www.biomedcentral.com)
Link to text: http://www.biomedcentral.com/content/pdf/1471-2474-12-136.pdf
