Orthotic management of fixed flexion deformity of the proximal interphalangeal joint following traumatic injury: A systematic review.
Nicole Young, Nichola Terrington, Diana Francis and 1 others
PMID 30186081WHAT IT FOUND
No orthosis type was shown to be better for post-traumatic PIPJ flexion contracture.
Splint and exercise programmes improved motion, but the splint alone cannot be credited and studies were too varied to guide a choice.
Key findings
01The review found no conclusive evidence that one orthotic design was superior for fixed flexion contracture resolution.
02All included studies reported improvement after orthotic treatment, but most also prescribed home exercise programmes, so the orthosis alone cannot be credited.
03Serial casting for six days of total end range time improved passive range of motion more than three days of total end range time.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only eight studies were included, and they were small and heterogeneous in design, orthosis type, force, wear time, and outcome measures. No included study directly compared static and dynamic orthoses, so the review could not answer which design is better. Seven of the eight studies also prescribed home exercise programmes, so the effect of the orthosis alone cannot be separated. Three included studies investigated multiple joints or deficit types, and four did not provide baseline fixed flexion deformity range-of-motion measures. No study used a standardised injury severity classification or a standardised functional outcome measure. Five studies did not specify whether total end range time was continuous or intermittent wear. The included studies were mostly conducted in Australia, and the review searched only English-language publications.
Declared interests
No funding or conflict-of-interest declaration is provided in the supplied text.
The easy way to misread this
Do not conclude that the orthosis alone improved the deformity. Most included studies also prescribed home exercise programmes, so the contribution of the orthosis alone cannot be separated.