Physiotherapy Department, The University of Sydney, Australia.
J Physiother. 2012;58(3):173-80. doi: 10.1016/S1836-9553(12)70108-X.
Do dynamic splints reduce contracture following distal radial fracture?
Assessor-blinded, randomised controlled trial.
Forty outpatients with contracture following distal radial fracture.
The control group received routine care consisting of exercises and advice for 8 weeks. In addition to routine care, during the day the experimental group received a dynamic splint, which stretched the wrist into extension but allowed intermittent movement.
The primary outcomes were passive wrist extension and the Patient Rated Hand Wrist Evaluation (PRHWE). The secondary outcomes were active wrist extension, flexion, radial deviation, and ulnar deviation, and the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM). All outcomes were measured at commencement, at the end of 8 weeks of treatment, and at 12 weeks (ie, 1 month follow-up).
The mean between-group difference for passive wrist extension and PRHWE at 8 weeks were 4 deg (95% CI -4 to 12) and -2 points (95% CI -8 to 4), respectively. The corresponding values at 12 week follow-up were 6 deg (95% CI 1 to 12) and 2 points (95% CI -5 to 9). There were no sufficiently important between-group differences for any of the secondary outcome measures at 8 or 12 weeks.
It is unclear whether dynamic splints following distal radial fracture have therapeutic effects on passive wrist extension or PRHWE, but they clearly do not have any therapeutic effects on active wrist extension, flexion, radial or ulnar deviation, or on the performance or satisfaction items of the COPM. The ongoing use of dynamic splints following distal radial fracture is difficult to justify.
ACTRN12608000309381.
动态夹板是否能减少桡骨远端骨折后的挛缩？
评估者设盲、随机对照试验。
40 名桡骨远端骨折后出现挛缩的门诊患者。
对照组接受常规护理，包括 8 周的锻炼和建议。除常规护理外，实验组白天还使用动态夹板，将手腕拉伸至伸展位，但允许间歇性运动。
主要结局是被动腕关节伸展和患者自评手腕评估（PRHWE）。次要结局是主动腕关节伸展、屈曲、桡偏和尺偏，以及加拿大职业表现测量（COPM）的表现和满意度项目。所有结局均在开始时、8 周治疗结束时和 12 周（即 1 个月随访时）进行测量。
8 周时，被动腕关节伸展和 PRHWE 的组间平均差异分别为 4 度（95%CI -4 至 12）和-2 分（95%CI -8 至 4）。12 周随访时，相应值分别为 6 度（95%CI 1 至 12）和 2 分（95%CI -5 至 9）。在 8 周和 12 周时，没有足够重要的组间差异在任何次要结局测量中。
目前尚不清楚桡骨远端骨折后使用动态夹板对被动腕关节伸展或 PRHWE 是否有治疗作用，但它们显然对主动腕关节伸展、屈曲、桡偏或尺偏，以及 COPM 的表现或满意度项目没有任何治疗作用。因此，难以证明桡骨远端骨折后持续使用动态夹板具有合理性。
ACTRN12608000309381。
