None listed
Conditions
Brief summary
Research Question: Does splinting and early mobilization in the dart-throwers plane of motion improve functional outcomes and reduce postoperative complications in people after scapho-lunate ligament repairs? Hypothesis: A dynamic splint configured to allow motion only in the dart thrower’s plane applied after plaster cast removal (this is determined by the surgeon according to operative technique, and is usually 6 weeks post surgery, but can be 4-10 weeks post surgery)will result in faster return to usual activities (including self-care, work and recreation) better patient ratings of function, less pain, and less post-operative complications than a static splint. Aim/s: To compare outcomes between two groups of patients – one of whom received the dynamic splint, the other the static splint at 12 weeks post scapho-lunate ligament repair - to determine whether patients recover more quickly, and rate their function and pain differently; and To see if a larger multi-centre study is feasible. Both groups will be advised that splints are to be removed only for hygiene and 2 hourly exercise program for 4 weeks, after which time it is phased out over the following 2 weeks. This means it is taken off for light activity at first, then ceased altogether.
Interventions
When the surgeon decides it is safe to remove the post-operative plaster cast (usually at 6 weeks, but can vary from 4-10 weeks depending on complexity of surgery) participants are randomised to 2 groups: intervention and control.
For the intervention group, a 2-part hinged splint will be fabricated which allows wrist motion in the Dart Throwing Plane. This is the normal motion the wrist would go through when thowing a dart or using a hammer, and involves a comination side-to-side and flexion /
When the surgeon decides it is safe to remove the post-operative plaster cast (usually at 6 weeks, but can vary from 4-10 weeks depending on complexity of surgery) participants are randomised to 2 groups: intervention and control. For the intervention group, a 2-part hinged splint will be fabricated which allows wrist motion in the Dart Throwing Plane. This is the normal motion the wrist would go through when thowing a dart or using a hammer, and involves a comination side-to-side and flexion / extension. The splint is to be removed only for hygiene and for exercise program every 2 hours during the day for the first 4 weeks, beginning with: - gentle wrist movement within patient's pain limits: wrist in mid-prone extension and flexion (no flexion beyond 30 degrees); wrist in supination ulnar and radial deviation; tenodesis exercise; dart-throw motion. These will be taught in the clinic, with correction of technique if necessary, then the participant continues the program at home. Participants are reviewed weekly to check progress until week 6. After first week: - add gentle isometric activation of flexor carpi radialis After third week: - add gentle isometric activation of: flexor carpi ulnaris, abductor pollicis longus, extensor carpi radialis longus and brevis. After 4 weeks, the splint can be removed for light activity (e.g. dressing, grooming, eating) but should be worn if pain flares or when doing more strenuous tasks. It should cease completely by week 6.
Sponsors
The Alfred
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All people who have had surgery to repair the scapho-lunate ligament in the previous 8 weeks
Exclusion criteria
- significant other injuries to the same limb, - co-existing rheumatological illness, - if they (or their carer / guardian) are not able to provide informed consent, or - if they are not able to speak or comprehend the English language.
Outcome results
None listed