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Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in newborns, ranging from mild dysplasia to complete dislocation. Early detection and intervention are crucial for managing DDH. However, in some cases, standard orthopedic treatments such as the Pavlik harness fail, and alternative approaches are needed. Our study explores the possibility that manual therapy, specifically the Mézières-Bertelè Method (MBM), could be beneficial in cases of DDH that are resistant to conventional treatments. We present a case of a 20-month-old female who had been suffering from persistent DDH (Graf's type IIIC on the left), pain and limping, despite previous conventional treatments, including the Pavlik harness. The patient received daily MBM sessions for six months, followed by maintenance sessions every two months. After undergoing the MBM treatment, the patient showed clinical improvements, such as normal neuromotor development and restored hip joint parameters. We observed normal walking and running abilities, and X-ray parameters returned to normal levels. The patient sustained positive outcomes during long-term follow-up until the age of 7. The MBM manual therapy was used to treat a challenging case of DDH resistant to conventional treatment. This case report suggests a possible correlation between manual therapy and improved outcomes in resistant DDH and highlights the potential relevance of addressing the inherent musculoskeletal components of the condition. [ABSTRACT FROM AUTHOR]

Background: Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate – termed cocaine-induced midline destructive lesions. Case report: A 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use. Conclusion: This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available. [ABSTRACT FROM AUTHOR]

Background: Longitudinal intervention studies on treatment options in temporomandibular dysfunction (TMD) including self reports and salivary biomarkers of stress are rare and the exact therapeutic function of occlusal splints widely unknown. Methods: We examined the therapeutic effects of a Michigan splint with occlusal relevance in patients with TMD using a placebo‐controlled, delayed‐start design. Two intervention groups received a Michigan splint, while one of them had a placebo palatine splint for the first 3 weeks. We collected pain intensities (at rest and after five occlusal movements), salivary measures associated with stress (cortisol and alpha‐amylase) and self‐reported psychological distress (stress, anxiety, catastrophizing) at baseline and 3 and 7 weeks after onset of intervention. Results: At baseline, we observed increased pain intensity and psychological distress in TMD patients compared to 11 matched healthy controls. Baseline anxiety was linked to movement pain intensity through stress. Over therapy reductions in pain intensity and morning cortisol were more pronounced in those patients starting immediately with the Michigan splint, while psychological distress decreased similarly in both groups. Conclusion: Our results suggest that perceived stress plays a role for the association between anxiety and TMD pain and underlines the need for an interdisciplinary perspective on the pathogenesis and therapy of TMD in a setting where psychotherapeutic knowledge is still scarce or rarely applied. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effects of four different immobilization methods [single sugar tong splint (SSTS), double sugar tong splint (DSTS), short arm cast (SAC), and long arm cast (LAC)] commonly used for restricting forearm rotation in the upper extremity. Methods: Forty healthy volunteers were included in the study. Dominant extremities were used for measurements. Basal pronation and supination of the forearm were measured with a custom-made goniometer, and the total rotation arc was calculated without any immobilization. Next, the measurements were repeated with the SAC, LAC, SSTS and DSTS. Each measurement was compared to the baseline value, and the percentage of rotation restriction was calculated. Results: The most superior restriction rates were observed for the LAC (p = 0.00). No statistically significant difference was detected between the SSTS and DSTS in terms of the restriction of supination, pronation or the rotation arc (p values, 1.00, 0.18, and 0.50, respectively). Statistically significant differences were not detected between the SAC and the SSTS in any of the three parameters (p values, 0.25; 1.00; 1.00, respectively). When the SAC and DSTS were compared, while there was no significant difference between the two methods in pronation (p = 0.50), a statistically significant difference was detected in supination (p = 0.01) and in the total rotation arc (p = 0.03). Conclusion: The LAC provides superior results in restricting forearm rotation. The SAC and SSTS had similar effects on forearm rotation. The DSTS, which contains, in addition to the SSTS, a sugar tong portion above the elbow, does not provide additional rotational stability. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint disorders (TMDs) are a variety of conditions that affect different parts of the temporomandibular joints (TMJ) and can cause orofacial pain and functional impairment. This study aims to investigate dental practitioners' knowledge and management of Temporomandibular Joint Disorders (TMDs), particularly their knowledge of the role physical therapy plays in TMD treatment. Methods: A mixed-methods approach was adopted to provide a comprehensive view of current knowledge, management practices, and attitudes toward collaboration among dental practitioners in treating TMD. Data were collected from a convenience sample of 335 dentists in Karachi using a detailed questionnaire to assess their knowledge of the role of physical therapy in the treatment of TMD. Twenty dentists were chosen for face-to-face, in-depth interviews to explore their experiences and challenges in managing TMDs based on their responses to the administered questionnaire. Results: The cumulative quantitative and qualitative findings of the study revealed a landscape marked by individualized approaches to referral practices and significant gaps in interdisciplinary collaboration. Most practitioners holding a bachelor's degree predominantly used medication (65.2%) and cause-specific treatment (65.3%) for TMD treatment. Thematic analysis of clinical efficacy and practitioner challenges in managing TMD revealed significant issues faced by dental professionals. Conclusions: The study successfully validated a questionnaire to understand dental practitioners' knowledge regarding physical therapy in TMD treatment. The study identified significant gaps in knowledge and a lack of collaboration between dentists and physiotherapists. The limited referral practices highlighted in the study, along with insights from dentist interviews, emphasize the need for improved interdisciplinary approaches to managing TMDs within dental practice. [ABSTRACT FROM AUTHOR]

Background: Non-operative management is typically indicated for extra-articular distal radius fractures. Conservative treatments such as Sugar tong splints (STs) and Muenster splints (MUs) are commonly used. However, there is limited research and outcome data comparing the two splint types. Therefore, this study aimed to investigate and compare the radiographic and clinical outcomes of treatment using STs and MUs. Methods: In this retrospective comparative study, we aimed to evaluate and compare the radiographic and clinical outcomes of STs and MUs for the treatment of distal radius fractures. The study included 64 patients who underwent closed reduction (CR) in the emergency room and were treated with either STs or MUs splints (STs group: n = 38, MUs group: n = 26). Initial X-rays, post-CR X-rays, and last outpatient follow-up X-rays were evaluated. Radial height (RH), ulnar variance (UV), radial inclination (RI), and volar tilt (VT) were measured by a blinded investigator. The Quick DASH form was applied to measure patients' satisfaction after treatments. Results: There were no significant differences in baseline characteristics, initial radiographic measurements, or radiographic measurements immediately after CR between the two groups. However, the overall radiological values deteriorated to some degree in both groups compared to the post-CR images. Furthermore, using a paired test, the STs group showed significant differences in RH and RI, and the MUs group showed significant differences in RH and UV between the last follow-up and post-CR images. Conclusions: The study concluded that there was no difference in clinical outcomes between the two splint types. However, both STs and MUs groups showed reduced radiographic parameters, and the MUs group showed a significant reduction of RH and UV in the treatment of distal radius fractures. Level of evidence: Level IV; Retrospective Comparison; Treatment Study. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). Study design: Prospective, double-blind, randomized controlled. Setting: University hospitals. Methods: Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. Results: Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month (P = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% (P = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. Conclusions: The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position. [ABSTRACT FROM AUTHOR]

Background: There is a controversy on the effectiveness of post-operating splinting in patients with carpal tunnel release (CTR) surgery. This study aimed to systematically evaluate various outcomes regarding the effectiveness of post-operating splinting in CTR surgery. Methods: Multiple databases, including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, were searched for terms related to carpal tunnel syndrome. A total of eight studies involving 596 patients were included in this meta-analysis. The quality of studies was evaluated, and their risk of bias was calculated using the methodological index for non‐randomized studies (MINORS) and Cochrane's collaboration tool for assessing the risk of bias in randomized controlled trials. Data including the visual analogue scale (VAS), pinch strength, grip strength, two-point discrimination, symptom severity score (SSS), and functional status scale (FSS) were extracted. Results: Our analysis showed no significant differences between the splinted and non-splinted groups based on the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. The calculated values of the standardized mean difference (SMD) or the weighted mean difference (WMD) and a 95% confidence interval (CI) for different variables were as follows: VAS [SMD = 0.004, 95% CI (-0.214, 0.222)], pinch strength [WMD = 1.061, 95% CI (-0.559, 2.681)], grip strength [SMD = 0.178, 95% CI (-0.014, 0.369)], SSS [WMD = 0.026, 95% CI (- 0.191, 0.242)], FSS [SMD = 0.089, 95% CI (-0.092, 0.269)], and the two-point discrimination [SMD = 0.557, 95% CI (-0.140, 1.253)]. Conclusions: Our findings revealed no statistically significant differences between the splinted and non-splinted groups in terms of the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. These results indicate that there is no substantial evidence supporting a significant advantage of post-operative splinting after CTR. [ABSTRACT FROM AUTHOR]

Background/Aim: Luxation is a common traumatic dental injury treated with a wire composite (WC) splint. However, bulk‐fill flowable composite and conventional packable composite have not been compared for retaining these splints. Therefore, the objectives of this randomized controlled trial were (1) to compare retention of WC splints, and (2) to compare adhesive point dimension, application and removal time, and effect on tooth mobility between the two WC splints. Materials and Methods: In this parallel group, non‐inferiority double blind randomized controlled trial, a total of 90 patients, aged 16–50 years participated. They were randomly allocated into two groups, the packable composite group (PC) n = 45 and the bulk‐fill flowable composite group (BF‐FC) n = 45 by lottery method. Following measurements were taken at the splint application appointment. Horizontal tooth mobility measured via Periotest, splint application time, and frontal images of splinted teeth to measure the percentage composite adhesive point area. After 2 weeks, splints were visually inspected for retention, whereas mobility and removal times were also recorded. Statistically, comparisons were made using independent samples sample T‐test, Fisher's exact test, and Mann–Whitney U at p ≤.05. Results: A total of 88 patients with 156 luxated teeth completed the trial, as two patients were lost to follow‐up. Two patients in the PC group reported with completely de‐bonded splints while none de‐bonded in the BF‐FC group. Both groups were similar in terms of splint retention (p =.352), reduction of mobility (p =.426), and splint removal times (p =.372). The BF‐FC group performed significantly better in adhesive point dimension percentages (p <.001) and splint application time (p <.001). Conclusion: Both groups were comparable in most parameters of the study. However, for BF‐FC group application time and adhesive point dimension were significantly less. [ABSTRACT FROM AUTHOR]

A 25-year-old man with a hip dislocation and Pipkin II type femoral head fracture, whose surgical treatment was postponed for 15 days due to Covid 19 pandemic, is described. For 2 months after surgery, treatment was supported by therapy in a hyperbaric chamber and with a continuous passive motion (CPM) splint. Four months after surgery, bone fusion of the femoral head fracture was achieved with its normal revascularization. Two years after the operation, the patient was moving efficiently and had no complaints of hip pain. Delayed open reduction and internal fixation of the femoral head fracture resulted in a very good functional and radiological outcome. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative antibiotic therapy is a common practice following septoplasty with intra‐septal splints placement (ISS), even though there is a lack of evidence to support it. We sought to investigate the role of antibiotic therapy in septal surgeries with the placement of ISS. Design: A retrospective comparative study was conducted using the electronic charts of adult patients who underwent septoplasty with the placement of ISS with or without turbinate reduction. Nasal cultures were taken routinely during surgery as part of the department's protocol for monitoring infectious diseases. The ISS were also routinely examined for the presence of bacteria after their removal on the eighth day following surgery. Setting: A large otolaryngology department in a tertiary medical center. Participants: Adult patients who underwent septoplasty in our institution. Main outcome measures: We analyzed all post‐operative infections to search for risk factors in the cohort. Results: Post‐operative infection rates following septoplasty with ISS were low at 6%, which is consistent with previously published rates. Infection rates were significantly higher in patients who were not treated with antibiotics (OR = 8.2, 95%CI: 1.63–41.1; p =.01, φ = 0.04). Diabetes was associated with an increased risk of postoperative infection regardless of prophylactic antibiotic therapy (OR = 5.2, 95%CI: 1.15–23.5; p =.032, φ =.04). The detection of Klebsiella pneumonia before surgery was associated with an increased rate of postoperative infection (OR = 16.6, 95%CI: 3.02–91.54; p =.001, φ = 0.12). Conclusions: Patients undergoing septoplasty with the placement of ISS are at increased risk of gram‐negative bacterial colonisation, and development of postoperative nasal infection. A single preoperative dose of IV antibiotic therapy should be considered a potential prophylactic option for septoplasty with ISS. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to compare the morbidity of different types of intranasal splints (Doyle splints and Reuter bivalve splints) with no intranasal splints in primary septal surgeries and concomitant submucosal reduction of the inferior turbinate. Design: Randomised clinical trial Setting: Single‐Center trial at a tertiary care facility Participants: In this randomised clinical trial, 123 consecutive patients underwent primary septoplasty with bilateral submucosal reduction of the inferior turbinate, with no other concurrent procedure. Patients were randomised into three groups: Doyle splints, Reuter bivalve splints and patients with no splints placed. Main Outcome Measures: Following surgery, the patients were seen at three consecutive visits. During each visit, the Visual Analogue Scale score for headache, nasal obstruction, overall pain and bleeding and an endoscopic score for secretions, oedema and synechiae was filled. Results: Patients were randomised into three groups, 42 received Doyle splints, 41 Reuter bivalve splints and 40 had no splints inserted. When comparing the three groups, the first two post‐op visits were scheduled significantly earlier in patients with splints (p <.05). The scores from both groups with splints were statistically higher for headache, nasal obstruction and pain, for the first visit only (p <.05). There was no statistical difference between groups when looking at each subset of the endoscopic score, at each visit (p >.05). Conclusion: Increased post‐operative pain, headaches and nasal obstruction scores were encountered in patients who had splints after surgery. However, endoscopic scores were statistically similar across the three groups with no difference in post‐operative endoscopic scores at each visit. and no difference was seen in symptom scores and endoscopic scores between patients with different splints. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS). Methods: After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity. Results: Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t -test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t -test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group. Conclusions: NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS. [ABSTRACT FROM AUTHOR]

Distal radius fractures are a common sports injury, often managed with reduction, immobilization, and rehabilitation. However, structured sport specific return to play protocols have yet to be developed, specifically within hockey. This case report reviews the various factors to consider when managing an athlete's recovery from a radius fracture, and objective measures to aid with return to play decision making when managing a hockey player. [ABSTRACT FROM AUTHOR]

Background: Subcutaneous spontaneous ruptures of the finger extensor tendons at the wrist frequently occur. This study aims to evaluate the outcomes of patients with extensor tendon ruptures treated by our operative methods and postoperative early active mobilization. Methods: A total of 38 patients with 68 extensor tendon ruptures were included in this study. In the reconstruction of extensor tendon ruptures, tendon transfers (extensor indicis proprius (EIP) tendon transfer and/or interlacing end-to-side suture) and/or free tendon bridge graftings were performed. Immediately after operation in all patients, early active mobilization began by wearing a specially designed bandage or splint. Results: There was no reoccurrence of re-rupture of a tendon post surgery. A patient satisfaction survey revealed that 29 patients rated their results as "excellent" and 9 were "good." Postoperatively, the active range of motion of the finger metacarpophalangeal (MP) joint averaged +3∘(range:- 14 ∼ +20∘) in extension and 69∘(range: 60–80∘) in flexion. Conclusions: We treated finger extensor tendon ruptures by tendon transfer (EIP tendon transfer to the ruptured extensor tendon and/or interlacing end-to-side suture) and/or bridge tendon grafting. We employed early active mobilization with patients wearing a specially designed bandage or splint immediately after reconstructing surgery. There was no case with re-rupture postoperatively. Our operative techniques and postoperative physiotherapy as early active mobilization in this study led to excellent results after finger extensor tendon ruptures. [ABSTRACT FROM AUTHOR]

The increasing demand for dental aesthetics, articulation corrections, and solutions for pain and frequent bruxism demands quick and effective restorative dental management. The biomedical research aimed to create a beneficial, ecological, and readily available anterior deprogrammer to determine the centric relation (CR) of cases. This medical device is additively manufactured from a biocompatible material. Size is customizable based on the width of the patient's anterior central incisors. This is a pilot study with two subjects. The task was to develop a complete data protocol for the production process, computer-aided design (CAD), and three-dimensional (3D) printing of the anterior deprogrammers. The research focused on creating simple and practically applicable tools for the dentist's prescription (anterior deprogrammer in three sizes), and secondly for the communication between the dentist and the patient (computer application). The tested hypothesis was whether, according to these novel tools, it is possible to produce functional occlusal splints, which could be manufactured using current technologies. This study compared a traditional splint with a digitally designed and 3D-printed one. The tested hypothesis was whether manufactured occlusal splints differ in patients' subjective perception of comfort. Each conservative treatment was monitored for ten weeks. Initial results are promising; no statistically significant difference was found between the productive technologies. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to compare the effects of Kinesio taping and night splinting along with physical therapy intervention on symptoms in patients with moderate carpal tunnel syndrome undergoing rehabilitation. Design: In this double-blind, randomized controlled trial, 45 patients with moderate carpal tunnel syndrome were included and randomly assigned to three groups: Kinesio taping group (n = 15), night splinting group (n = 15), and control group (n = 15). All patients received 20 physical therapy intervention sessions. The primary outcome was self-reported disability status measured by the Boston Carpal Tunnel Questionnaire, and secondary outcomes were pain and paresthesia (rest, activity, and night) measured by the Numeric Rating Scale. Outcomes were recorded at baseline and 4 wks. Results: All patients showed clinically meaningful improvements for all outcome measures over time ( P < 0.05). The intergroup analysis revealed that the Kinesio taping group demonstrated better results in all measures than the night splinting ( P < 0.05) except for pain during activity ( P = 0.054), at night ( P = 0.191), and paresthesia at rest ( P = 0.575). In addition, the Kinesio taping group showed better outcomes than the control group ( P < 0.05) except for the activity pain ( P = 0.022). However, there were negligible differences between night splinting and control group ( P > 0.05). Conclusion: Kinesio taping in combination with physical therapy intervention is more effective than night splinting in combination with physical therapy intervention or physical therapy intervention alone and may be recommended. [ABSTRACT FROM AUTHOR]

BACKGROUND: The minimally invasive endodontics could retain more peri-cervical dentin (PCD) and other important dental structures, thus realizing the minimal loss of teeth structures and preserving the strength and function of the endodontically treated tooth (ETT). The search for abnormal root canals or calcified root canals could be quite time-consuming and increase the risk of perforation. OBJECTIVE: This study introduced a novel multifunctional 3D printing guided splint inspired by the dice, which can achieve the minimally invasive access cavity preparation and canal orifice identification. METHOD: Data were collected from an outpatient with dens invaginatus. Cone-beam Computed Tomography (CBCT) revealed a type III invagination. The CBCT data of the patient were imported into a computer-aided design (CAD) software (Exocad 3.0; Exocad GmbH) for the 3D reconstruction of jaw bones and teeth. The dice-inspired 3D printing guided splint consists of the sleeve and guided splint. The sleeve with minimal invasive opening channel and orifice locating channel were designed with a reverse-engineering software (Geomagic Wrap 2021). The reconstructed models in the Standard Template Library (STL) format were imported into a CAD software. The design of the template was aided by the dental CAD software in Splint Design Mode. The sleeve and splint were exported into the STL files separately. A 3D printer (ProJet ® 3600 3D Systems) was used to separately generate the sleeve and guided splint, and was made by stereolithography and processed in a medical resin (VisiJet M3 StonePlast). RESULTS: The novel multifunctional 3D printing guided splint could be set in position. The opening side in the sleeve was selected and the sleeve was inserted in place. The minimal invasive opening was made in the crown of the tooth to access the pulp. The sleeve was draw out and turned to the orifice location side, and then inserted in place. The target orifice was located rapidly. CONCLUSION: This novel dice-inspired multifunctional 3D printing guided splint allow dental practitioners to gain accurate, conservative, and safe cavity access from teeth with anatomical malformations. Complex operations might be carried out with less reliance on the operator's experience than with conventional access preparations. This novel dice-inspired multifunctional 3D printing guided splint would have a broad application in the dental field. [ABSTRACT FROM AUTHOR]

Background Steroid injection and splinting, which are commonly recommended nonsurgical treatments in adults with trigger finger, have been demonstrated to effectively relieve pain and improve function. However, to our knowledge, there have been no direct comparisons of pain relief and function improvement with splinting alone, steroid injection alone, or a combination of splinting and steroid injection in patients with this diagnosis. Question/purpose Are there differences in pain reduction and functional improvement in adults with trigger finger treated with splinting alone, steroid injection alone, and a combination of splinting and steroid injection at 6, 12, and 52 weeks after the intervention? Methods Between May 2021 and December 2021, we treated 165 adult patients for trigger finger at an academic university hospital. Based on prespecified criteria, all patients we saw during that period were eligible, but 27% (45 of 165) were excluded because they had received a previous local corticosteroid injection (n = 10) or they had concomitant carpal tunnel syndrome (n = 14), first carpometacarpal joint arthritis (n = 3), osteoarthritis of the hand (n = 6), de Quervain disease (n = 3), multiple-digit trigger finger (n = 6), or pregnancy during the study period (n = 3). After screening, 120 patients were randomized to receive either splinting (n = 43), steroid injection (n = 40), or splinting plus steroid injection (n = 37). Patients were randomly assigned to the different treatments using computer-generated block randomization (block of six). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. Both the allocator and the outcome assessor were blinded. Splinting involved the patient wearing a fixed metacarpophalangeal joint orthosis in the neutral position at least 8 hours per day for 6 consecutive weeks. Steroid injection was performed using 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) injected directly into the flexor tendon sheath.No patientswere lost to follow-up or had treatment failure (that is, the patient had persistent pain or triggering with the trigger finger treatment and requested additional medical management including additional splinting, steroid injection, or surgery) at 6 or 12 weeks after the intervention, and at 52 weeks, there was no difference in loss to follow-up among the treatment groups. An intention-totreat analysis was performed with all 120 patients, and a perprotocol analysis was conducted with 86 patients after excluding patients who were lost to follow-up or had treatment failure. Primary outcomes evaluated were VAS pain reduction and improvement in Michigan Hand Outcomes Questionnaire (MHQ) scores at 6, 12, and 52 weeks after the intervention. The minimum clinically important difference (MCID) values were 1 and 10.9 for the VAS and MHQ, respectively. Results There were no clinically important differences in VAS pain scores among the three treatment groups at any timepoint, in either the intention-to-treat or the per-protocol analyses. Likewise, there were no clinically important differences in MHQ scores at any timepoint in either the intention-to-treat or the per-protocol analyses. Conclusion Splinting alone is recommended as the initial treatment for adultswith trigger finger because therewere no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. The combination of steroid injection and splinting is disadvantageous because the benefits in terms of pain reduction and symptom or functional improvement are not different from those achieved with steroid injection or splinting alone. Level of Evidence Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

There is limited literature evidence on the use of relative motion flexion splint after flexor tendon repairs. We aimed to report the clinical use of early active movement with a relative motion flexion splint and to determine the outcomes of a consecutive series in patients with zone 1–2 flexor tendon repair. We included 14 patients with one-stage flexor tendon repair. An active rehabilitation program was initiated in the first week with a static dorsal block splint, which was removed in the third week, and patients started to use the relative motion flexion splint. Total active motion (TAM) of the injured finger at 8, 12, and 16 weeks after surgery was assessed as described by Strickland and Glogovac. The mean TAM of the injured fingers was as follows: 102.5 ± 41.49° (25°–180°) at week 8; 123.42 ± 40.94° (45°–190°) at week 12; and 148 ± 38.18° (90°– 200°) at week 16. Final TAM grades of the patients at week 16 were as follows: excellent (six patients); good (five patients); and fair (three patients). There were no tendon ruptures and secondary surgeries. Early active movement and the use of relative motion flexion splint seem to be promising strategies for flexor tendon zone 1–2 repair management. [ABSTRACT FROM AUTHOR]

To evaluate and compare the mechanical properties, water sorption, water solubility, and degree of double bond conversion of three different commercially available three-dimensional (3D) printing resins used for the fabrication of flexible occlusal splints. A digital printer was used to generate specimens from the evaluated splint materials (KeySplint Soft, IMPRIMO LC Splint flex, and V-Print splint comfort). The specimens were equally divided and tested either dry or after water storage at 37 °C for 30 days. A three-point bending test was used to assess flexural strength, elastic modulus, and fracture toughness. A two-body wear test was performed using a dual-axis chewing simulator. Water sorption and water solubility were measured after 30 days. The degree of double bond conversion was determined by FTIR-spectrometry. All data for the evaluated properties were collected and statistically analyzed. Both material and storage conditions had a significant effect on the flexural strength (P < 0.001), elastic modulus (P < 0.001), fracture toughness (P < 0.001), and wear (P < 0.001). The highest water sorption was noticed with IMPRIMO LC Splint flex (1.9 ± 0.0 %), while V-Print splint comfort displayed the lowest water solubility (0.2 ± 0.0 %). For the degree of conversion, it was statistically non-significant among the different materials (P = 0.087). Different flexible 3D-printed splints available in the market displayed variations in the evaluated properties and clinicians should consider these differences when choosing occlusal device materials. Among the tested flexible splint materials, KeySplint Soft had the greatest flexural strength, elastic modulus, fracture toughness, wear resistance, and degree of conversion. It also showed the lowest water sorption. [ABSTRACT FROM AUTHOR]

Background: Anterior repositioning splint (ARS) is used to treat temporomandibular joint (TMJ) disc displacement with reduction (DDwR). However, high recurrence rate remains a problem especially in patients with unstable occlusions. Objective: This study optimised standard ARS therapy and proposed a step‐back ARS retraction (SAR) method in adult patients with DDwR. Methods: Dental examinations and magnetic resonance imaging of TMJ were obtained before treatment (T0), 1 to 3 months (T1), 3 to 6 months (T2) and 6 to 12 months (T3) during treatment in 48 adults (average age 27.1 ± 5.7 years). After 3 months of basic ARS wearing, personalised treatment for patients with normal disc–condyle relationship was prescribed depending on bilaminar zone adaptations and severity of molar openbite. SAR which required sequential ARS wearing was designed for patients with deep overbite/overjet until retrodiscal tissue adaptations and stable occlusions were achieved. Results: The maximum interincisal opening was increased from 44.3 ± 6.9 to 45.3 ± 6.3 mm (p <.01), and joint pain was alleviated after ARS treatment. The overall success rate of ARS wearing was 92.1% (58/63) featured by a recaptured disc. Fifteen patients who underwent SAR therapy all showed bilaminar zone adaptations in the end, and one patient had positive condylar bone remodelling. Conclusions: ARS treatment could improve mouth opening and joint symptoms in adult DDwR patients. SAR method was suitable for treating DDwR patients with deep overbite and overjet and improved retrodiscal tissue adaptations and condylar bone remodelling. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to examine the short-termeffectiveness of a prefabricated wrist orthosis compared with a custom-made wrist orthosis and its long-term effectiveness on alleviating carpal tunnel syndrome (CTS) symptoms. Materials and Methods: A total of 109 patients withmild and moderate CTS were prescribed with either a prefabricated wrist or a custom-made wrist orthosis, and the changes in their mean scores on the Carpal Tunnel Syndrome Symptom Severity Scale (CTSSSS) at baseline and the eighth week follow-up. The changes in CTSSSS scores of those prescribed with the prefabricated wrist orthosis were compared with the 32nd week postintervention. Results: Repeated-measures analysis of variance (ANOVA) showed significant effect at both mean CTSSSS and subscale scores ( P < 0.001). Both prefabricated wrist orthosis (n = 88) and custom-made wrist orthosis (n = 21) were shown to alleviate CTS symptoms at the first follow-up. Repeated-measures ANOVA showed significant differences after the long-term application of the prefabricated wrist orthosis (n = 62) in terms of CTSSSS score, daytime numbness, nighttime numbness, and nocturnal awakening ( P = 0.005--0.029). Clinical Relevance: Along with the conventional thermoplastic splint, the prefabricated soft wrist orthosis could serve as an appropriate alternative to alleviate neurological symptoms of CTS due to its better long-term compliance. [ABSTRACT FROM AUTHOR]

Introduction: Rheumatoid arthritis (RA) causes structural damage that causes joint deformity including metacarpophalangeal (MCP) joint ulnar drift (UD), thus hindering the pinch strength and the functional ability of the hand. Orthosis or splints are designed to maintain the hand's function, improve joint alignment, restore biomechanical balance, and reduce tissue stress. Limited studies have been done on the effects of dynamic splint on pinch strength and functional ability. Therefore, the purpose of this study was to evaluate and quantify the effects of dynamic MCP splint in treatment of ulnar deviation of RA on pinch strength and functional ability in women. Methods: Twenty women with RA were recruited and completed a 4-week intervention period with dynamic MCP splint. Pinch strength and functional ability score were measured at baseline and after 4 weeks. Results: The results showed a significant improvement in pinch strength (mean ± SD, 11.68 ± 2.14 to 13.53 ± 2.14; P = 0.000) and functional ability score (mean ± SD, 22.70 ± 9.12 to 19.70 ± 8.14; P = 0.000). Conclusion: The results of this study show that the dynamic MCP splint had a positive impact on rheumatoid hands that align the joints in their functional position. The dynamic MCP splint improved the mechanical stability of the hand, thus reducing pain and stress on joints, which in turn improves the pinch strength and functional ability of rheumatoid hand. Clinical Relevance: To increase patient acceptance and use of the splint, the splint designed and used in this study was compact and only covered the affected areas and joints of the hand. Because there was no involvement of the wrist joint and the fingertips were free, the splint was lightweight and allowed the patient to perform activity while wearing it. [ABSTRACT FROM AUTHOR]

Background: Emergence delirium (ED) is generally occurred after anesthesia associated with increased risks of long-term adverse outcomes. Therefore, this study aimed to evaluate the efficacy of preconditioning with nasal splint and mouth-breathing training on prevention of ED after general anesthesia. Methods: This randomized controlled trial enrolled 200 adult patients undergoing ESS. Patients were randomized to receive either nasal splinting and mouth breathing training (n = 100) or standard care (n = 100) before surgery. The primary outcome was the occurrence of ED within 30 min of extubation, assessed using the Riker Sedation-Agitation Scale. Logistic regression identified risk factors for ED. Results: Totally 200 patients were randomized and 182 aged from 18 to 82 years with 59.9% of males were included in the final analysis (90 in C-group and 92 in P-group). ED occurred in 16.3% of the intervention group vs. 35.6% of controls (P = 0.004). Male sex, smoking and function endoscopic sinus surgery (FESS) were independent risk factors for ED. Conclusions: Preoperative nasal splinting and mouth breathing training significantly reduced the incidence of emergence delirium in patients undergoing endoscopic sinus surgery. Trial Registration: ChiCTR1900024925 (https://www.chictr.org.cn/index.aspx) registered on 3/8/2019. [ABSTRACT FROM AUTHOR]

Purpose: Post operation infection after septoplasty is very rare, possibly due to excessive nasal blood supply. Most otorhinolaryngologists recommend antibiotics after septoplasty; however, controversial results were available. Therefore, this study was designed to investigate the effect of antibiotics after septoplasty. Methods: In this study, 90 patients who were candidates for septoplasty were entered the study and divided into three groups. The first group did not receive any oral antibiotics after septoplasty. The second group took 500 mg of oral cephalexin. The third group, for whom splints were used, also received cephalexin. The culture of the nasal mucosa was prepared before and two weeks after surgery and compared between groups. Then, the amount and types of mucosa microorganisms were reported. Data were analyzed using SPSS16. Results: The growth significantly increased in the first group (p = 0.051) and reduced in the second group (p < 0.001). While a decreased growth rate was observed in the third group, it was not statistically significant (p = 0.12). Conclusion: The present study highlighted the beneficial role of prophylactic antibiotics administration in patients without splints on bacterial growth, while it had no effect in patients with splints. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of offset on the precision of three-dimensional (3D)-printed splints, proposing to optimize the splint design to compensate for systematic errors. Materials and methods: 14 resin model sets were scanned and offset as a whole by given distances (0.05, 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, and 0.40 mm). Intermediate splints (ISs) and final splints (FSs) were generated from the non-offset and offset models and grouped correspondingly, named as splint type-offset value, IS-0.05, for instance. Dentitions occluded with the splint were scanned. Translational and rotational deviations of the lower dentition relative to the upper dentition were 3D measured. Results: Deviations of ISs and FSs were more evident in the vertical and pitch dimensions, and were mostly acceptable in other dimensions. ISs with offset ≥ 0.05 mm showed vertical deviations significantly below 1 mm (P < 0.05) while ISs with 0.10- to 0.30-mm offsets had pitch rotations significantly lower than 1° (P < 0.05). The Pitch of IS-0.35 was significantly larger than ISs with 0.15- to 0.30-mm offsets (P < 0.05). Meanwhile, FSs fit better as the offset increased and FSs with offsets ≥ 0.15 mm all had deviations significantly lower than 1 mm (for translation) or 1° (for rotation) (P < 0.05). Conclusions: Offset affects the precision of 3D-printed splints. Moderate offset values of 0.10 to 0.30 mm are recommendable for ISs. Offset values ≥ 0.15 mm are recommended for FSs in cases with stable final occlusion. Clinical relevance: This study found the optimal offset ranges for 3D-printed ISs and FSs via a standardized protocol. [ABSTRACT FROM AUTHOR]

The optimal balance between mechanical environment and biological factors is crucial for successful bone healing, as they synergistically affect bone development. Any imbalance between these factors can lead to impaired bone healing, resulting in delayed union or non-union. To address this bone healing disorder, clinicians have adopted a technique known as "dynamization" which involves modifying the stiffness properties of the fixator. This technique facilitates the establishment of a favorable mechanical and biological environment by changing a rigid fixator to a more flexible one that promotes bone healing. However, the dynamization of fixators is selective for certain types of non-union and can result in complications or failure to heal if applied to inappropriate non-unions. This review aims to summarize the indications for dynamization, as well as introduce a novel dynamic locking plate and various techniques for dynamization of fixators (intramedullary nails, steel plates, external fixators) in femur and tibial fractures. Additionally, Factors associated with the effectiveness of dynamization are explored in response to the variation in dynamization success rates seen in clinical studies. [ABSTRACT FROM AUTHOR]

Context: Many patients report poor therapeutic outcomes following mallet finger fracture surgery . A more reliable technique is urgently needed. Objective: To present a novel treatment for mallet finger fractures using a 2 - step orthosis method. Design: Prospective, observational study. Semng Hospital . Participants : Patients with mallet finger fractures. Interventions: The finger is fixed with splints for 6 weeks, including 3 weeks for the proximal interphalangeal joint in the flexion position and the distal interphalangeal joint in the hyperextension position (first splint) and 3 weeks for the distal interphalangeal joint in the hyperextension position (second splint). Up to week 8, the second splint was attached at night and during physical exertion. Main Outcome Measures: Crawford criteria, Abouna-Brown criteria, bone fusion, grip strength, Doyle classification, Ishiguro classification . Results : Sufficient bone fusion was achieved 12 weeks after fixation ; at which time, the range of motion with the distal interphalangeal joint flexed, and extended in the 3 patients was 50° and 0°, 70° and -3°, and 60° and 0°, respectively. The right and left hand grip strengths in the 3 patients were 58 and 55 kg, 62 and 58 kg, and 31 and 29 kg, respectively: there were no problems with respect to function or work. The first 2 patients could start sports again with partial return after 1 week and complete return after 12 weeks and 8 weeks, respectively. For the third patient. rehabilitation was complete after 16 weeks. Evaluation of the fracture sites based on the Crawford criteria showed the condition to be perfect, and evaluation based on the Abouna-Brown criteria showed success . Conclusions : This method provides satisfactory fixation and can prevent proximal interphalangeal joint contracture. Favorable long-term outcomes were con firmed in all patients, suggesting that this method may be effective for previously untreated mallet finger fractures with little displacement. [ABSTRACT FROM AUTHOR]

Objective: The isolated second metacarpal base fracture‐dislocations in adults are rare, and the traditional main treatments include closed reduction with the plaster or splint and open reduction with internal fixation (ORIF). However, closed reduction with the plaster or splint is not solid enough and ORIF can damage the surrounding important tissues. The purpose of this study was to explore the clinical outcomes of closed reduction and external fixation (CREF) for the treatment of isolated second metacarpal base fracture‐dislocations. Methods: Ten patients who suffered isolated second metacarpal base fracture‐dislocations between January 1, 2010, and February 1, 2020, were reviewed. All of the patients were treated by CREF. Radiographs and computed tomography scans were performed regularly after the operation. The grip and pinch strength, visual analog scale (VAS) pain score, American Society for Surgery of the Hand total active movement (TAM) and total active flexion (TAF) scores, Cooney score, Sollerman hand function test (SHFT) score, QuickDASH score, and range of motion of the index finger were recorded at the last follow‐up visit to evaluate functional recovery; the injured and healthy hands were compared and we also recorded postoperative complications. The paired samples t‐test was used to compare the healthy and injured sides. Results: The patients were followed up for a median of 29.50 ± 4.2 months. There were no significant differences in the grip strength, pinch strength, angle of proximal interphalangeal joint (PIPJ) flexion, or angle of distal interphalangeal joint (DIPJ) flexion between the injured and healthy sides at the final follow‐up visit (all p > 0.05). The mean TAM (268.20 ± 4.21) and TAF scores (270.60 ± 4.17) on injured side were significantly lower than those on healthy side (all p < 0.05). The mean Cooney score (93.50 ± 7.47) and SHFT score (78.50 ± 1.08) on injured side were lower, while the mean QuickDASH score (7.05 ± 3.11) on injured side was higher than those on healthy side (all p < 0.05). The mean VAS pain score was 0.50 ± 0.53 on injured side. There were no significant postoperative complications except for traumatic arthritis in one patient without obvious clinical symptoms. Conclusion: CREF achieves the satisfactory curative effect, and the patients obtain the good functional recovery without significant postoperative complications. CREF is a safe and effective treatment for isolated second metacarpal base fracture‐dislocations with satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this quality improvement project is to assess and improve the quality of splint application in the emergency department (ED), as well as the splint application confidence level of the ED staff. Consistent and high-quality splint application is critical in fracture stabilization and prevention of further injury. Significantly high turnover and a lack of formal training of ED staff has led to poor splint application, and in some cases, patient injuries related to the splints themselves. These injuries include pain, edema, and skin complications (A. P. Carino, 2017). A random, Likert-based analysis was performed on 20 ED-applied splints. Once analysis was complete, training courses were implemented to improve splint application techniques. Using the same Likert-based tool, applications of 20 posttraining splints were analyzed. In addition, ED staff confidence levels were scored before and after the training courses. Overall, statistically significant improvement was achieved in splint application quality and staff confidence. Correct splint applications increased from 50% to 95% after the educational sessions. Staff confidence in splint application also increased, from 35% to 77.1%. Quality splint application affects all patients. The higher risk population is more likely to suffer the consequences of poor splint application. This project had a positive impact on the region's marginalized patient population. These patients have limited resources, including lack of transportation, financial limitations, and typically are at higher risk for complications due to comorbidities. [ABSTRACT FROM AUTHOR]

Mirror hand (ulnar dimelia) is a very rare congenital anomaly of the upper extremity. This report presents the results of a therapy programme given to a patient with mirror hand. Pollicisation, opponensplasty, triceps lengthening and elbow arthrolysis were performed when the child was 2, 3, 4 and 7 years old respectively. Hand rehabilitation was planned in early (4–8 weeks), mid (9–12 weeks), and late (12 weeks) postoperative periods. The main purposes of the rehabilitation were to help the child recognise their hands and to use them functionally, ensure cortical reorganisation, improve independence and participate in activities of daily living. Range of motion, muscle and grip strength, sensation and hand function assessment results from an 8-year follow-up are presented. After 8 years of follow-up, the child was able to use his hand functionally, his grip strength was 1 kg, and his sensation was typical. Although he was independent in performing activities of daily living, because he did not have sufficient elbow flexion, he used excessive wrist flexion in some activities. The treatment was satisfactory for the child and the family. The child displayed typical motor development similar to his peers. Planning the treatment and therapy in coordination with hand surgeons is essential for optimal hand function. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have reported altered neural activity in the motor cortex after short-term cast immobilization, even in healthy participants. However, the effects of short-term movement restriction on tissue structure are not well understood. OBJECTIVE: To investigate the effects of short-term lower limb immobilization on muscle tissue hardness. METHODS: Seventeen healthy participants were enrolled in the study. Each participant's non-dominant lower limb was fixed with a soft bandage and medical splint for 10 h. Gastrocnemius muscle tissue hardness was measured using a tissue hardness meter before cast application and immediately after cast removal. Measurements were performed five times for each lower limb, and the three values with the lowest coefficient of variance were adopted as the value of muscle tissue hardness. RESULTS: Gastrocnemius muscle tissue hardness in the immobilized limb was lower after cast removal than that before cast application (from 53.6 to 51.8; p < 0.01), whereas the non-fixed limb showed an increase in muscle tissue hardness at the end of the experiment (from 52.9 to 54.3; p = 0.03). CONCLUSION: The findings indicate that 10 h movement restriction induced a reduction in muscle tissue hardness, suggesting acute adverse effects of cast immobilization for orthopedic treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and clinical usefulness of deep learning (DL)-accelerated turbo spin echo (TSEDL) sequences relative to standard TSE sequences (TSES) for acute radius fracture patients wearing a splint. Methods: This prospective consecutive study investigated 50 patients' preoperative wrist MRI scans acquired between July 2021 and January 2022. Examinations were performed at 3 Tesla MRI with body array coils due to the wrist splint. Besides TSES obtained according to the routine protocol, TSEDL sequences for axial T2-, coronal T1-, and coronal PD-weighted TSE sequences were scanned for comparison. For quantitative assessment, the relative signal-to-noise ratio (rSNR), the relative contrast-to-noise ratio (rCNR), and the relative contrast ratio (rCR) were measured. For qualitative assessment, all images were assessed by two independent musculoskeletal radiologists in terms of perceived SNR, image contrast, image sharpness, artifacts disturbing evaluation, overall image quality and diagnostic confidence for injuries using a four- or five-point Likert scale. Results: The scan time was shortened approximately by a factor of two for TSEDL compared to TSES. TSEDL images showed significantly better rSNR, rCNR, and rCR values for all sequences, and scored significantly better in terms of both image quality and diagnostic confidence for both readers than TSES images (all p <.05). Interrater reliabilities were in almost perfect agreement. Conclusion: The DL-accelerated technique proved to be very helpful not only to reduce scan time but also to improve image quality for acute painful fracture patients wearing a splint despite using body array coils instead of a wrist-specific coil. Based on our study, the DL-accelerated technique can be very useful for MRI of any part of the extremities in trauma settings just with body array coils. [ABSTRACT FROM AUTHOR]

Objectives: To measure the degree of conversion (DC) of different 3D printing resins used for splints or orthodontic appliances under different postpolymerization conditions. Materials and methods: Five 3D-printed photopolymer resins were studied. Each resin was analyzed in liquid form (n = 15), and then cylindrical specimens (n = 135) were additively manufactured and postcured with Form Cure (Formlabs) at different times (10, 60, and 90 min) and temperatures (20 °C, 60 °C, and 80 °C). The DC of each specimen was measured with Fourier transform infrared spectroscopy (FTIR). The data were statistically analyzed using a 3-way ANOVA followed by Tukey's post hoc test. Results: The time and temperature of postpolymerization significantly influenced the DC of each resin: when time and/or temperature increased, the DC increased. For all resins tested, the lowest DC was obtained with a postcuring protocol at 10 min and 20 °C, and the highest DC was obtained at 90 min and 80 °C. However, at 80 °C, the samples showed a yellowish color. Conclusions: With the Form Cure device, the time and temperature of postcuring could have an impact on the DC of the 3D printing resins studied. The DC of the 3D printing resins could be optimized by adjusting the postpolymerization protocol. Clinical relevance: Regardless of the resin used, when using the Form Cure device, postcuring at 60 min and 60 °C would be the minimal time and temperature conditions for achieving proper polymerization. Beyond that, it would be preferable to increase the postcuring time to boost the DC. [ABSTRACT FROM AUTHOR]

Context: Plantar fasciitis is one of the most common foot injuries. Several mechanical treatment options, including shoe inserts, ankle-foot orthoses, tape, and shoes are used to relieve the symptoms of plantar fasciitis. Objectives: To investigate the effectiveness of mechanical treatment in the management of plantar fasciitis. Evidence acquisition: The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. A systematic search was performed in PubMed, CINAHL, Embase, and Cochrane up to March 8, 2018. Two independent reviewers screened eligible articles and assessed risk of bias using the Cochrane Collaboration's risk of bias tool. Evidence synthesis: A total of 43 articles were included in the study, evaluating 2837 patients. Comparisons were made between no treatment and treatment with insoles, tape, ankle-foot orthoses including night splints and shoes. Tape, ankle-foot orthoses, and shoes were also compared with insoles. Follow-up ranged from 3 to 5 days to 12 months. Cointerventions were present in 26 studies. Conclusions: Mechanical treatment can be beneficial in relieving symptoms related to plantar fasciitis. Contoured full-length insoles are more effective in relieving symptoms related to plantar fasciitis than heel cups. Combining night splints or rocker shoes with insoles enhances improvement in pain relief and function compared with rocker shoes, night splints, or insoles alone. Taping is an effective short-term treatment. Future studies should aim to improve methodological quality using blinding, allocation concealment, avoid cointerventions, and use biomechanical measures of treatment effects. [ABSTRACT FROM AUTHOR]

Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgically-induced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease. [ABSTRACT FROM AUTHOR]

Introduction. Plantar fasciitis (PF) is a subcalcaneal pain syndrome that affects 10-16% of the world's population. The use of foot and ankle splinting allows the talocrural joints to be in anatomical position, reducing the contracture and tension generated by pain and PF. Objective. To review the literature on the effectiveness of night splinting in plantar fasciitis. Materials and methods. Seven databases were used, and EndNote Web and Rayyan reference managers were employed. After exclusion of duplicate articles, Phase 1 - reading of titles and abstracts and Phase 2 - reading of the full texts according to the eligibility criteria by two blinded reviewers (R1 and R2) and discrepancies resolved by the third reviewer (R3). Risk of bias assessment was performed by blinded R1 and R2 with the Cochrane tool, Rob 2. Results. The references of 258 studies were identified, 144 from the major databases and 114 from grey literature. Finally, three randomized clinical trials were included in this review. A high risk of overall bias was found in the 3 studies included in this review. Conclusions. It is concluded that the use of the night splint improves pain and function in individuals with plantar fasciitis. However, due to the high risk of bias obtained, there is needed with such a statement, and more primary studies are needed. Study registration. The project has been registered in PROSPERO under number CRD42021285287. [ABSTRACT FROM AUTHOR]

Objective: To analyse the effectiveness of exercise therapy in improving pain and active or passive maximum mouth opening in patients with temporomandibular disorders. Data sources: PubMed Medline, Web of Science, Scopus, CINAHL Complete and Physiotherapy Evidence Database, until April 2022, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Review methods: We included randomized controlled trials evaluating the effect of exercise therapy on pain and on active and passive maximum mouth opening in patients with temporomandibular disorders. Effect size was calculated using Cohen's standardized mean difference (SMD) and their 95% confidence interval (95% CI) in a random-effects model. Results: A total of 16 studies with 812 participants were included. Exercise therapy is effective in reducing pain (SMD: −0.58; 95% CI: −1.01 to −0.12) and increasing the pain pressure threshold (SMD: 0.45; 95% CI: 0.14–0.76), active and passive maximum mouth opening (SMD: 0.43; 95% CI: 0.14–0.71 and SMD: 0.4; 95% CI: 0.06–0.75, respectively). Subgroup analyses showed more effect of exercise therapy more splints versus splints on pain (SMD: −0.5; 95% CI: −0.73 to −0.26), active and passive maximum mouth opening (SMD: 1.14; 95% CI: 0.22–2.07 and SMD: 0.56; 95% CI: 0.06–1.06, respectively). On pain pressure threshold, exercise therapy was better than physiotherapy approach (manual therapy and electrotherapy) (SMD: 0.48; 95% CI: 0.09–0.87). Conclusions: Therapeutic exercise is an effective therapy to reduce pain and increase pain pressure threshold and active and passive maximum mouth opening in patients with temporomandibular disorders. [ABSTRACT FROM AUTHOR]

Objective: This study aims to find out the effect of the topical lidocaine pomade application on postoperative bleeding and pain control following a septoplasty procedure. Material and Methods: We enrolled 82 (45 male, 37 female) patients with a mean age of 31.8±8.58 (range 16-51) who underwent septoplasty. Forty five (56.88%) of them received Doyle nasal splint with a %5 lidocaine pomade, and 37 (42.12%) patients received Doyle nasal splint only. Visual analog scale (VAS) was used to measure postoperative pain intensity on the first, 2nd, and 3rd days after septoplasty before taking painkillers. Duration of postoperative bleedy nasal discharge time (hours) and hospitalization period were recorded. Complications were also recorded. Results: There was no significant difference between nasal pack groups in terms of hospitalization period (p=0.383). There was a significant difference between nasal pack groups in terms of first, 2nd, and 3rd postoperative day VAS scores. VAS scores in Doyle nasal pack group were significantly higher every 3 days. When VAS scores of postoperative first, 2nd, and 3rd days were compared, there was a significant difference between all of the groups. While the first day's VAS score was the highest, the 3rd day was the lowest. Duration of the postoperative bleedy discharge period was found significantly lower in patients with Doyle splint with lidocaine pomade (p<0.001). Conclusion: Consequently, using lidocaine pomade covered nasal silicone splints is a comfortable, reasonable and cost-effective option for patients who underwent septoplasty. It helps postoperative pain management and shortens the duration of the postoperative bleedy discharge time. [ABSTRACT FROM AUTHOR]

Objective: The effectiveness of high-intensity laser therapy (HILT) has been demonstrated in some musculoskeletal repetitive strain injury disorders. This study aimed to determine the short-term effectiveness of HILT in de Quervain tenosynovitis (DQT). Methods: Sixty-four patients with DQT diagnosis (32 males, 32 females; 18-65 years) were randomly divided into two groups. A short opponens splint was applied to both groups and HILT to the treatment group and sham HILT to the control group once a day, on alternate days, 3 days a week, for 5 weeks. Pre- and post-treatment evaluations were made using a visual analog scale (VAS); Quick Disabilities of the Arm, Shoulder, and Hand questionnaire; Short Form-36 Health Survey; and hand grip strength test. Results: The demographic results (age, gender, duration of complaint, body mass index, occupational group) of both groups were similar (p>0.05). The pre-treatment measured values were similar in both groups (p>0.05). After a 5-week treatment, a significant improvement was observed in all parameters in both groups. Post-treatment, hand grip strength levels were statistically higher in the HILT group than in the sham therapy group, and VAS levels were significantly lower (p<0.001). Conclusions: HILT is a non-invasive and reliable method that increases grip strength and decreases pain in DQT. [ABSTRACT FROM AUTHOR]

Summary of background data: The results of conventional corrective procedures remain suboptimal for severe cubitus varus deformities (> 30°) in children. We present the results of shortening dome osteotomy for the correction of such deformities. Patients and methods: We present retrospective review of prospectively collected data of 18 patients (11 boys and 7 girls) who underwent shortening dome osteotomy between January 2011 and December 2019 for severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture. The procedure involved the removal of convexo-concave bone (5–8 mm wide) between the two domes. Humero-ulnar angles, lateral condylar prominence index (LCPI), and elbow range of movements were recorded preoperatively and postoperatively. Results: Mean age was 7.5 years (range 5 years–11 years). Indication for surgery was poor cosmesis in all the patients and tardy ulnar nerve symptoms in three patients. Mean preoperative humero-ulnar angle was 26.1° varus (range 22°–34°), while it was 7.1° valgus (range 0°–12°) for contralateral normal elbow. They were followed for a mean duration of 2.2 years (range 12 months–5.8 years). The mean postoperative valgus angle achieved was 7.3° (range 2°–12°) as total angular correction achieved was 34.4° (range 30°–44°) (p < 0.001). Radiological healing was observed in all the patients at mean duration of 7.1 weeks (range 5 weeks–9 weeks). Mean preoperative and postoperative LCPI were − 2.4 (range +4.7 to − 10.5) and − 1.7 (range +4.5 to − 5.1), respectively (p = 0.595). Three patients had pin tract infections and two of them responded to aseptic dressings and oral antibiotics, while another required early pin removal and additional protection in splint. All patients regained preoperative arc of motion within 6 months after the procedure. Conclusion: Shortening dome osteotomy is a safe and effective method for correcting severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture in children. [ABSTRACT FROM AUTHOR]

Background: Stabilisation splint therapy (SST) and low‐level laser therapy (LLLT) are effective‐invasive treatment for temporo‐mandibular disorder (TMD) patients. However, the specific efficacy of each therapy in patients with chronic closed lock (CCL) from temporo‐mandibular joints (TMJ) disc displacement without reduction (DDwoR) remains unknown. Objectives: The aim of this study was to assess and compare the efficacy of SST and LLLT alone or in combination in patients with CCL from TMJ DDwoR. Methods: This parallel randomised clinical trial included 42 patients who were diagnosed with CCL from TMJ DDwoR. Patients were allocated equally and randomly into three treatment groups: group I received combined SST and LLLT, group II received LLLT and group III received SST. Maximum mouth opening (MMO), visual analogue scale (VAS), muscle and joint palpation scores and time required to achieve normal state were evaluated at baseline, 1, 2, 4 weeks, 3 and 6 months after the intervention. Data were collected and analysed using SPSS software. Results: Regarding MMO and VAS, a statistically significant improvement was found between group I versus group II and versus group III at all evaluation times. Regarding muscle and joint palpation scores, a statistically significant difference was found between group I versus group III, while non‐significant difference was found between group I and group II. A statistically significant faster improvement was found in group I versus group III and versus group II. Conclusion: All treatment modalities can be effective in management of CCL from a TMJ DDwoR cases, but the combined SST and LLLT group seems to provide the best and quickest improvement. Clinical trial registration number: NCT05548894. [ABSTRACT FROM AUTHOR]

Background: Osteogenesis imperfecta (OI) is a hereditary genetic disorder characterized by bone fragility and extremity deformities. The surgical management for long-bone fractures and deformities in OI remains a challenge. We aimed to compare clinical outcomes after femoral surgery splinted with the telescopic rod, the plate and screws, the elastic nail and the non-elongating rod in setting of OI. Methods: A retrospective cohort study included 783 femoral procedures (mean age 6.00 (interquartile range (IQR) 5.00) years, 335 (42.8%) females) was conducted, and individuals were categorized into four groups according to implants. After verifying comparability among the groups, revision rate and implant survival period were compared among the Sillence types and the same comparison were made among four groups within each Sillence type. The incidence of refractures, deformities, and implant-related complications were also compared among the four groups. Results: There were no significant differences in demographic information among the four groups in terms of sex (p = 0.101), laterality (p = 0.587), Sillence type (p = 0.122), and postoperative follow-up period (p = 0.214). In total, children with Sillence type III had the highest revision rate and the shortest implant survival period; children with Sillence type I had the lowest revision rate and the longest implant survival period; and children with Sillence type IV had the revision rate and the implant survival period between those observed in Sillence types I and III. In Sillence types III and IV, the telescopic rod had lower revision rate (III 24.8%; IV 20.9%) compared to the plate (III 97.2%, p<0.001; IV 80.3%, p<0.001), the elastic nail (III 100.0%, p=0.019; IV 73.9%, p<0.001) and the non-elongating rod (III 65.0%, p<0.001; IV46.9%, p<0.001); the median implant survival period of the telescopic rod (III 48.00 (IQR 28.50) months; IV 43.00 (33.00) months) is longer than the plate (III 11.00 (9.00) months, p<0.001; IV 19.00 (20.00) months, p<0.001), the elastic nail (III 45.00 (37.75) months, p=1.000; IV 19.00 (35.00) months, p=0.028) and the non-elongating rod (III 39.00 (31.75) months, p=0.473; IV 38.50 (29.75) months, p=1.000).A similar trend was observed in Sillence type I (p = 0.063, p = 0.003; respectively). In addition, the incidence of refracture (15.5%), deformity (2.8%) and implant-related complications (23.1%) were also statistically lower in the telescopic rod group. Conclusion: In our cohort, lower revision rate and longer implant survival period were observed in telescopic rod group. This was mainly due to the significant lower incidence of refracture, deformity and implant-related complications with the use of telescopic rod. [ABSTRACT FROM AUTHOR]

Mallet finger is a commonly encountered condition in daily practice. However, there is currently no consensus on whether surgical intervention or conservative treatment with orthosis splint is superior. In this systematic review and meta-analysis, we compare the treatment outcomes between surgery and orthosis for bony and tendinous mallet finger. We searched PubMed, Embase, and the Cochrane Library according to the PRISMA guidelines from inception to January 15, 2021. The primary outcome was distal interphalangeal (DIP) joint extension lag angle, and secondary outcomes were DIP joint flexion and range of motion (ROM) angle. A total of 297 studies were initially identified, of which 13 (ten retrospective non-randomized controlled studies (non-RCTs) and three RCTs) were included in the final analysis. The results of this systematic review and meta-analysis showed that there was no high level of evidence supporting the superiority of surgery over orthosis in the treatment of mallet finger. Based on the available evidence, surgical intervention and conservative treatment with splint may offer similar clinical outcomes in both bony and tendinous mallet finger. [ABSTRACT FROM AUTHOR]

Objectives This follow-up study of the INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) trial compared the effects of corticosteroid injection (CSI) and night splinting (NS) for the initial management of mild-to-moderate CTS on symptoms, resource use and carpal tunnel surgery, over 24 months. Methods Adults with mild-to-moderate CTS were randomized 1:1 to a local corticosteroid injection or a night splint worn for 6 weeks. Outcomes at 12 and 24 months included the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity numeric rating scale (NRS), the number of patients referred for and undergoing CTS surgery, and healthcare utilization. A cost–utility analysis was conducted. Results One hundred and sixteen participants received a CSI and 118 a NS. The response rate at 24 months was 73% in the CSI arm and 71% in the NS arm. By 24 months, a greater proportion of the CSI group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery compared with the NS group. There were no statistically significant between-group differences in BCTQ score or pain NRS at 12 or 24 months. CSI was more costly [mean difference £68.59 (95% CI: −120.84, 291.24)] with fewer quality-adjusted life-years than NS over 24 months [mean difference −0.022 (95% CI: −0.093, 0.045)]. Conclusion Over 24 months, surgical intervention rates were low in both groups, but less frequent in the NS group. While there were no differences in the clinical effectiveness of CSI and NS, initial treatment with CSI may not be cost-effective in the long-term compared with NS. [ABSTRACT FROM AUTHOR]

Background and purpose -- At our institution, newborns with Barlow or Ortolani positive hips have been treated for 12 weeks with the von Rosen abduction splint until 2012 when the treatment length was halved. We investigate whether acetabular development at 12 months of age and complications differ between hips treated with the von Rosen splint for 6 compared with 12 weeks. Patients and methods -- 99 patients were included in the 6-week program and 138 patients in the 12-week program. We measured the acetabular index (AI) on standard anteroposterior pelvic radiographs taken at 12 months of age. Medical records were reviewed for complications and additional treatments until age 12 months. We used non-inferiority testing with an equivalence margin of 1° with a 95% confidence interval (CI) to compare the 2 groups. Results -- The mean AI at 12 months in the 6-week group was 25° (CI 24-26) compared with 25° (CI 25-26) in the 12-week group. Non-inferiority was demonstrated for the 6-week program: -0.2° (CI -1.1 to 0.7). In the 6-week group, 8 patients received additional treatment, including 1 hip dislocation that occurred between 6 weeks and 3 months. There were no additional treatments or complications in the 12-week group. Conclusion -- AI was equal at 12 months of age for patients treated for 6 compared with 12 weeks in the von Rosen splint. The hip dislocation which occurred indicates that follow-up around 3 months of age is indicated. [ABSTRACT FROM AUTHOR]

Background The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. Literature search was performed using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Results Of the 1,079 retrieved studies, 20 were eligible for analysis and included 687 cases of ulnar neuropathy at the elbow. Improvement of symptoms was reported in 54% of the cases receiving a steroid/lidocaine injection (95% confidence interval [CI], 41–67) and in 89% of the cases using a splint device (95% CI, 69–99). Conclusions Conservative management seems to be effective. Both lidocaine/steroid injections and splint devices gave a statistically significant improvement of symptoms and are suitable options for patients who refuse an operative procedure or need a bridge to their surgery. Splinting is preferred over injections, as it shows a higher rate of improvement. [ABSTRACT FROM AUTHOR]

Background: Hand tendon reconstruction is required in both acute and chronic tendon injuries. A number of donor sites have been described; one such novel donor site is semitendinosus tendon used a graft for hand tendon reconstruction. Based on data reviewed, only a few cases are described up till now. Objective: Utility of semitendinosus tendon graft with adequacy of tendon material for hand tendon reconstruction and minimal donor site morbidity Methods: Semitendinosus tendon was utilized in total of 18 patients undergoing tendon reconstruction for chronic tendon injuries and for tendon transfer to achieve adequate length. All cases were performed during January 2019 To December 2020. Full length uni/bilateral semi-tendinosus tendon was harvested using a tendon harvester. Tendon was used as a single slip or was split into further slips as needed for tendon reconstruction. Post operatively splints were continued as per protocol (keeping splint for 6 weeks, encouraging active physiotherapy at 8 weeks, continuing night splintage for total of 10 weeks and advising patient to avoid lifting heavy weight for at least 12 weeks). Patients were followed with assessment of strength via MRC (Medical Research Council) grading scale, and tendon excursion measurements via tip to palm distance. Results: Patients had a mean age for 27.5±2.3 with a predominant male population (72.2%). Post-operative assessment showed finger strength of MRC 5 in twelve patients and MRC 4 in three and MRC 3 in three patients. Tendon excursion was documented measuring a tip to palm distance. Three patients developed tendon adhesions which were treated with tenolysis. Conclusion: Semitendinosus is a recommended option for hand tendon (both flexor & extensor) reconstruction, providing adequate length & strength for reconstruction with high predictable availability and reliability. Although Palmaris longus remains the recommended option for single tendon reconstruction, it is absent in a few cases or is rudimentary, making it difficult to be utilized. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare percutaneous pinning versus splinting of soft tissue mallet finger injury to determine if there are differences in residual extensor lag and complication rates. Methods: Patients ≥18 years of age undergoing mallet finger injury treatment from 2011 to 2020 were retrospectively reviewed. Exclusion criteria included bony or open mallet finger injury and incomplete documentation of residual extensor lag at final follow-up. Complications, including infection, hardware fixation failure and wound complications, were collected from follow-up clinic notes. Those treated with percutaneous pinning were compared to those treated non-surgically with splinting. Results: Of the 150 soft tissue mallet finger injuries that met the inclusion criteria, 126 were treated with splinting, and 24 were treated with percutaneous pinning. There were no differences in residual extensor lag between groups (Splinting: 5.4°, Pinning: 5.8°, p = 0.874). However, the pinning group had a higher overall complication rate than the splinting group (20.8% vs. 1.6%, p = 0.001). Conclusions: Surgery may be an effective treatment method for soft tissue mallet finger, but due to the higher rate of complication and the increased expense of a surgical procedure, splinting should be the preferred treatment method for most of these injuries. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]