» Articles » PMID: 21693044

Night-time Splinting After Fasciectomy or Dermo-fasciectomy for Dupuytren's Contracture: a Pragmatic, Multi-centre, Randomised Controlled Trial

Overview
Publisher Biomed Central
Specialties Orthopedics
Physiology
Date 2011 Jun 23
PMID 21693044
Citations 24
Authors
Affiliations
Soon will be listed here.
Abstract

Background: Dupuytren's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting, however the evidence supporting night splinting is of low quality and equivocal.

Methods: A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77) or hand therapy with night-splinting (n = 77). Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat.

Results: 148 (96%) patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0-100 scale: adjusted mean diff. 0.66, 95%CI - 2.79 to 4.11, p = 0.703), total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI -2.33 to 12.55, p = 0.172) or patient satisfaction (0-10 numerical rating scale: adjusted mean diff -0.35, 95%CI -1.04 to 0.34, p = 0.315) at 1 year post surgery. Similarly, in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes.

Conclusions: No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists' time, thermoplastic materials and the potential inconvenience to patients having to wear a device, the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur.

Trial Registration: The trial was registered as an International Standard Randomised Controlled Trial ISRCTN57079614.

Citing Articles

Percutaneous Needle Fasciotomy Versus Limited Fasciectomy for Dupuytren Disease: A Linear Model Assessment of Short-term Efficacy.

Kwok J, Shtarbanov P, Giwa L, Toft N, Nikkhah D, Kang N Plast Reconstr Surg Glob Open. 2024; 12(11):e6326.

PMID: 39583785 PMC: 11584222. DOI: 10.1097/GOX.0000000000006326.


Sex Difference in the Treatment of Dupuytren's Disease: A Systematic Review and Meta-Analysis of Clinical Trials.

Saggaf M, Liu K, Ho G, Anastakis E, Baltzer H Plast Surg (Oakv). 2024; 32(3):374-383.

PMID: 39104932 PMC: 11298125. DOI: 10.1177/22925503221141707.


Needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contractures of the fingers (Hand-2): study protocol for a randomised controlled trial.

Harrison S, Ogollah R, Hollingworth W, Mills N, Karantana A, Blazeby J Trials. 2024; 25(1):398.

PMID: 38898458 PMC: 11186219. DOI: 10.1186/s13063-024-08003-1.


Comparison of Hand Therapy with or without Splinting Postfasciectomy for Dupuytren's Contracture: Systematic Review and Meta-Analysis.

Karam M, Kahlar N, Abul A, Rahman S, Pinder R J Hand Microsurg. 2023; 14(4):308-314.

PMID: 36994455 PMC: 10042625. DOI: 10.1055/s-0041-1725221.


Dutch Multidisciplinary Guideline on Dupuytren Disease.

Kemler M, de Wijn R, van Rijssen A, van Kooij Y, Ottenhof M, van Heijl M J Hand Surg Glob Online. 2023; 5(2):178-183.

PMID: 36974283 PMC: 10039301. DOI: 10.1016/j.jhsg.2022.11.008.


References
1.
Hurst L, Badalamente M, Hentz V, Hotchkiss R, Kaplan F, Meals R . Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009; 361(10):968-79. DOI: 10.1056/NEJMoa0810866. View

2.
Ellis B, Bruton A . A study to compare the reliability of composite finger flexion with goniometry for measurement of range of motion in the hand. Clin Rehabil. 2002; 16(5):562-70. DOI: 10.1191/0269215502cr513oa. View

3.
Dias J, Braybrooke J . Dupuytren's contracture: an audit of the outcomes of surgery. J Hand Surg Br. 2006; 31(5):514-21. DOI: 10.1016/j.jhsb.2006.05.005. View

4.
Gummesson C, Atroshi I, Ekdahl C . The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003; 4:11. PMC: 165599. DOI: 10.1186/1471-2474-4-11. View

5.
Evans R, Dell P, Fiolkowski P . A clinical report of the effect of mechanical stress on functional results after fasciectomy for Dupuytren's contracture. J Hand Ther. 2002; 15(4):331-9. DOI: 10.1016/s0894-1130(02)80004-7. View