Dynamic splints do not reduce contracture following distal radial fracture: a randomised controlled trial

Question: Do dynamic splints reduce contracture following distal radial fracture? Design: Assessor-blinded, randomised controlled trial. Participants: Forty outpatients with contracture following distal radial fracture. Intervention: 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. Outcome measures: 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). Results: 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. Conclusion: 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. Trial registration: ACTRN12608000309381. [Jongs RA, Harvey LA, Gwinn T, Lucas BR (2012) Dynamic splints do not reduce contracture following distal radial fracture: a randomised controlled trial. Journal of Physiotherapy 58:173-180]