Serial splintage: Preoperative treatment of upper limb contracture

Introduction

The present study aimed to study the efficacy of preoperative splints in treatment of upper limb contractures and to evaluate the response of contracture to splints depending on the etiology and the joint involved.

Methods

Ninety joints of 42 patients were studied. Patients age, gender, etiology, duration of contracture, contracture site and joint and type of contracture was noted. The range of motion of the involved joint was recorded. Serial static splints made of thermoplastic material were applied after customizing them for each patient. The range of motion and percentage movement was recorded at weekly interval and the splints were modified as per need. Time taken to reach a plateau stage was noted. To compare the statistical significance between two groups and more than two groups of continuous variable unpaired t-test and one way ANOVA respectively was applied. We considered differences to be statistically significant when the p value was below 0.05. The strength of relationship between the two continuous variables was analyzed by Pearson correlation analysis.

Results

Etiological factors were thermal burns (36.7%), electrical burns (13.3%), post traumatic (35.6%) and post cellulitis (14.4%). Age ranged from 2 to 70 years with a mean of 28.9 ± 13.4 years. Sixty-two patients treated were males (68.9%) and 28 were female (31.1%). The mean range of motion present across all joints before starting the therapy was 54.7 ± 23.6 degrees. The mean improvement in contracture angle obtained by serial splintage was 37.4 ± 28.1 degrees. The mean time taken to achieve plateau was 23.6 ± 3.2 days. Maximum improvement was seen in thermal burn contractures (41.2 ± 30.3 degrees). Least improvement was seen in contractures due to cellulitis (6.5 ± 16.2 degrees). This finding was statistically significant [F(3,86) = 4.25, p = 0.005]. Significant difference was seen in response to therapy based on the joint involved [F(3,86) = 3.36, p = 0.02]. Highest improvement in the range of motion was seen in the metacarpophalangeal joint (49.61 ± 31.3 degrees).

Conclusions

The preoperative use of splints may lead to lesser surgical intervention and in selective cases obviate surgery. Thermal burns which are the most common cause of contractures of the upper limb, show the maximum response to preoperative serial splintage. Patient with minor contracture and supple tissues are fully corrected with splints without surgical intervention. In patients undergoing surgical correction, skin graft decreases due to decreased contracture angle.