Advances in Hand Therapy: Best practice in conservative management of proximal phalangeal fractures in children.

Intervention: Splinting (group 1) vs no splinting (group 2) of proximal phalangeal fractures that have been clinically assessed as being healed at 3 weeks post injury. All face to face interventions will be delivered at The Children's Hospital at Westmead outpatient department. Visit 1, 30 minutes (within 2 weeks post fracture) - Study information will be provided to potential participants. - Fabrication of a thermoplastic splint and instructions given about full-time wearing regime and precautions. Visit 2, 30 minutes (range 3 weeks to 4 weeks post immobilisation) - Administration staff to obtain consent. - Eligibility for stage 2 inclusion will be assessed by a senior hand therapist - For those eligible envelope randomization will be used to determine study group - All participants will have total active motion (TAM) measures recorded of their affected digit/s and the contralateral digit/s on the unaffected hand. TAM will be measured using a rolyan goniometer. - Participants randomly allocated to Group 1 standard treatment will commence AROM exercises three times per day. Those with finger injuries will commence tendon gliding exercises x 10 repetitions and finger lifts x 10 repetitions. Those with thumb injuries will commence thumb finger touch x 10 repetitions and slides x 10 repetitions. Participants will be instructed to remove their splints for exercises and light functional use at home only. Splints must be worn overnight, for school and for high risk activities. - Participants allocated to the Group 2 new protocol group will commence the same exercises as those who receive standard treatment, as outlined above. Participants will be instructed to cease splinting from this appointment. They are able to resume light activities and will be advised not to participate in sports or high risk activities. Therapists will advise the participant to buddy tape the affected finger to the adjacent finger if there is concern about the participant’s ability to follow safety instructions. - Participants will then be booked in with a different senior hand therapist/investigator for their 5 week follow up appointment which will ensure blinding of therapists. Visit 3, 30 minutes (5 weeks to 6 weeks post immobilisation) - Participants will attend their scheduled appointment and check in with reception staff. For participants in group 1 who are wearing splints reception staff will ask them to take their splint off to ensure investigators are blinded to their group allocation. - Participants will have TAM measures recorded of their affected digit/s and the contralateral digit/s on the unaffected hand. TAM will be measured using a rolyan goniometer. - Participants will have grip strength measured, and those with thumb fractures will also have lateral pinch strength measured using a citec dynamometer. Participants will be instructed to hold their elbow by their side and at approximately 90 degrees of flexion. The investigator will give verbal instructions and modeling will be used to assist with position. 3 measures will be taken for the unaffected hand and then the affected hand and an average for each hand will be calculated and recorded. - The patient rated questionnaire PRQ will be administered during the session with questions being asked verbally by the therapist and yes/no responses being recorded. - Average grip strength, TAM measures and PRQ scores will be entered into an excel spreadsheet. - The therapist can then be unblinded and review EMR notes if required. - Commence light strengthening for all participants in both group - Parents/guardians will be given a choice for follow-up contact at 8 weeks post injury – either email, text or phone call. Week 8, 5 minutes - PRQ can be texted, emailed or a phone call will be made. Four attempts will be made to contact participants. Did not attend appointment - Reception staff will contact and determine why they did not attend. Attempts will be made to book them in ASAP in order to capture all participants at the appropriate time.