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OBJECTIVES: Current studies on the treatment of adolescent patients with disc displacement without reduction (DDWOR) are limited by short follow-up periods and small sample sizes, and there are few comparative studies on the efficacy of conservative treatment with and without disc reduction for acute DDWOR. This study compared the therapeutic effects of two conservative treatment methods: physical therapy alone and physical therapy combined with non-surgical manual disc reduction and anterior repositioning splints (ARS), in adolescent patients with acute DDWOR. MATERIALS AND METHODS: This retrospective study included adolescent patients with DDWOR who underwent physical therapy at the Temporomandibular Joint Rehabilitation Department of the Shanghai Ninth People's Hospital from January 2018 to December 2021. Patient assessment data were collected before and after treatment. Patients were followed up through telephone and online questionnaires from March to August 2023. RESULTS: The results indicate that compared to physical therapy alone, the combination of physical therapy and non-surgical manual disc reduction with ARS showed better short-term efficacy, improved mouth opening, and better long-term pain control. Also, it may be effective in preventing degenerative joint disease. CONCLUSIONS: This combination therapy is recommended for clinical application in adolescent patients with acute DDWOR. CLINICAL RELEVANCE: The present research demonstrates the superior efficacy of physical therapy and non-surgical manual disc reduction combined with anterior repositioning splint in adolescent patients with acute DDWOR.

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A meta-analysis including all relevant randomized controlled trials was conducted to compare soft bandage, splint and cast as the treatment of torus fracture. PubMed, Scopus, and Web of Science databases were searched in January 2023. Two comparisons were made: (1) splint versus cast, and (2) bandage versus rigid immobilization (i.e. splint or cast). Main outcomes were pain, clinical healing of the fracture and return to activities. Secondary outcomes were adverse events (skin issues, problems with cast/splint/bandage) and patient/parental satisfaction. Seven studies with 1550 patients were included. Splint was associated with higher pain scores at 3 days compared to cast (Mean difference [MD] 1.00, CI 0.06-1.94) and at 1 week (MD 1.46, CI 0.84-2.08, moderate-certainty evidence), but faster return to activities (at 3 weeks RR 1.77, CI 1.09-2.88, at 4 weeks RR 1.44, CI 1.11-1.82, moderate-certainty evidence). All torus fractures heal clinically within 3-4 weeks (low-certainty evidence). Bandage may lead to slightly higher pain score (MD 0.35, CI 0.04-0.66, moderate-certainty evidence) at first day after treatment compared to rigid immobilization, but no evidence of a difference was found in later time points. In conclusion, soft bandage or removable wrist splint seem to be optimal first-line treatment of distal forearm torus fracture.

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Adhesion of the middle turbinate to the lateral wall of the nasal cavity and synechia of the middle meatus are one of the common reasons for the failure of surgical interventions for chronic sinusitis. The use of specially shaped intranasal splints can solve the problem of preventing synechiae in the postoperative period. Many different devices and approaches have been proposed to prevent the development of this category of complications. This study proposes an anatomical version of the splint for the middle turbinate, developed using 3D computer modeling technologies followed by printing from a biocompatible elastic material on a Formlabs 3BL 3D printer. The shape and size of the splint were developed based on the analysis of computed tomography data of 50 adult patients. The safety of the developed device was studied in a group of 20 volunteers in whom the developed splint was installed on one side of the nasal cavity for 2 weeks after bilateral surgery. According to endoscopic examination and patient questionnaires, the developed splint did not cause local or systemic allergic reactions and did not create additional discomfort for the patient in the postoperative period. Installing a splint helped prevent the formation of synechiae. However, to determine clinical effectiveness, a study with a larger sample of patients is required.

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Metacarpal fractures produce significant hand disability, and non-operative management of these fractures can produce satisfactory functional outcomes with few complications. However, most studies assessing non-operative outcomes of metacarpal fractures revolves around metacarpals I and V, which possess different anatomy. Therefore, further investigation into outcomes after non-operative treatment of metacarpals II-IV is required to inform management decisions and allow modification of the rehabilitation protocols to specific fracture patterns. All records for 76 non-operative patients presenting with fractures of metacarpals II-IV to our tertiary centre in the year 2019 were retrospectively reviewed. Patients were treated with thermoplastic splinting or fibreglass casting with a rehabilitative exercise programme. Range of motion (ROM) of the Metacarpophalangeal (MCPJ), Proximal Interphalangeal (PIPJ), and Distal Interphalangeal joints (DIPJ), return to work time, and complications were assessed at 12 weeks post-treatment. Mean return to work time was 5.4 weeks, and patients did not report any serious adverse events; the main complication reported was tenderness on palpation (20%). The MCPJ exhibited the poorest ROM (9° flexion reduction relative to the healthy hand). Metacarpal II fractures were associated with significantly worse MCPJ flexion than metacarpal III (p = 0.022) and metacarpal IV (p = 0.049) fractures. Fractures of the metacarpal base were associated with superior MCPJ flexion (p = 0.004) but longer return to work time (p = 0.042) than head fractures. Spiral fractures were associated with shorter return to work time (p = 0.043) and superior ROM results (p = 0.041). In conclusion, outcomes of the non-operative treatment of metacarpal II-IV fractures are highly dependent on the location and pattern of the fracture, and this should be considered during clinical decision making.

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Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs. Operative management options include arthrodesis and arthroplasty, which can be further broken down into silicone implants and 2 component resurfacing implants. The article summarizes the current literature for each of the treatment options for metacarpophalangeal joint arthritis of the index finger.

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BACKGROUND: Evidence supports the use of hand-based metacarpophalangeal joint (MCPJ) blocking splints as an intervention for trigger finger (TF). In practice, finger-based relative motion (RM) splints are also implemented without evidence. PURPOSE: This randomized comparative trial (RCT) aims to evaluate implementation of MCPJ blocking and RM splints for effectiveness, function, occupational performance and wearability after 6 weeks of TF management. METHODS AND ANALYSIS: Priori analysis determined 36 individuals were needed for random assignment to the RM or MCPJ blocking splint groups. Individuals must be aged ≥21 years, and diagnosed with TF involving ≥1 finger. For blinding purposes, the primary author screens for eligibility, fabricates the splints and educates. Therapist A administers the primary outcome measures Week-1 and Week-6-stage of stenosing tenosynovitis and secondary outcome measures- number of triggering events in 10 active fists, visual analog scales (VAS) for pain, splint comfort and satisfaction, Disabilities of the Arm, Shoulder and Hand, and Canadian Occupational Performance Measure. Therapist B in Week-3 instructs participants in deep tissue massage and administers splint wearability VASs. The RM pencil test is used to determine the affected finger(s) MCPJ splint position i.e., more extension or flexion based on participant response. The MCPJ blocking splint holds the MCPJ in a neutral position. Analysis involves a mixed-effects ANOVA to compare Week-1 and Week-6 primary and secondary outcomes. RESULTS: Recruitment and data collection are ongoing. DISCUSSION: Biomechanically RM splints control tendon excursion and reduce passive tendon tension while allowing unencumbered finger motion and hand function. Hence clinicians use RM splints as an intervention for TF, despite the lack of implementation evidence. This RCT implements a function-focused as well as patient-centered approach with partial blinding of assessors and participants. CONCLUSION: We anticipate that this study will provide evidence for the implementation of RM splints to manage adults with TF. TRIAL REGISTRATION: Clinical trial registration This trial is registered with ClinicalTrials.gov (NCT05763017).

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ABSTRACT: This review covers common orthopedic injuries seen after acute traumatic injury. A thorough physical examination and radiographic review of these injuries are key to ensuring appropriate management. Although many injuries may require urgent or emergent orthopedic consultation and management, this review focuses on injuries that are low-risk and amenable to splinting with outpatient orthopedic follow-up. This review covers key physical examination features, radiographic findings that help providers assess injuries, as well as reviewing splinting application to help facilitate rapid management of these injuries in the acute care setting.

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The current research paper was designed to assess the impact of an intra-articular injection of injectable platelet-rich fibrin (I-PRF) following arthrocentesis and the use of an anterior repositioning splint (ARS) as a proposed treatment approach for addressing symptomatic internal derangement of the temporomandibular joint (TMJ). This study comprised thirty patients who presented with bilateral disc displacement without reduction. The patients were evenly distributed into two groups: Group I underwent treatment involving ARS and arthrocentesis alone, while Group II underwent treatment with ARS, arthrocentesis, and the injection of I-PRF. Clinical assessment of all patients was done postoperatively in the following intervals; first week, first month, third month, and six months for maximum mouth opening (MMO), right and left lateral excursion, and pain score. Magnetic resonance imaging (MRI) assessment for all joints was done at the sixth month postoperatively. Both groups demonstrated improvement in MMO, lateral excursion, and pain. Significant statistical differences were observed in the mean values of MMO and Visual Analogue Scale (VAS), favouring the I-PRF group. MRI postoperatively showed no significant changes in disk position or morphology at the end of the sixth month. Administering an intra-articular I-PRF injection subsequent to arthrocentesis demonstrates effectiveness as a treatment approach for alleviating the signs and symptoms associated with internal derangement of the TMJ.

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The purpose of this systematic review was to compare the effectiveness of stabilisation splint (SS) with other conservative treatment modalities in the management of temporomandibular disorders (TMD). An electronic search in PubMed, Google Scholar, and Cochrane was conducted to find randomised control trials published on the management of temporomandibular disorders in English language from March 2000 to June 2023 along with manual search in the relevant Journal of Prosthetic Dentistry, the American Journal of Prosthodontics, and the Journal of Oral Rehabilitation. A total of 64 studies were initially considered, out of which eight studies fulfilled the inclusion criteria. Furthermore, RoB-2 analysis tool was used for checking the risk of bias in the included studies. On comparing the readings and outcomes, only one study showed that the SS was better than the comparators. The review identified that there is weak evidence of effectiveness of SS splint therapy over other conservative therapies for the treatment of TMD. Key Words: Splints, Conservative treatment, Pain measurement, Temporomandibular disorders.

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Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, paresthesia, and, less often, weakness in the distribution of the median nerve. Provocative maneuvers, such as the Phalen test and Tinel sign, have varying sensitivity and specificity for the diagnosis of CTS. Thenar atrophy is a late finding and highly specific for CTS. Although patients with a classic presentation of CTS do not need additional testing for diagnosis, electrodiagnostic studies can confirm the diagnosis in atypical cases, exclude other causes, and gauge severity for surgical prognosis. An abnormal nerve conduction study is useful for ruling in CTS, but a normal test does not necessarily exclude it. Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, have not shown benefit for CTS. Patients with mild to moderate CTS initially may be offered nonsurgical treatments, such as splinting or local corticosteroid injections. Night-only splinting is as effective as continuous wear. A neutral wrist splint may be more effective than an extension splint. In patients with recent onset of CTS, corticosteroid injections provide slightly greater improvement of symptoms compared with splinting at 6 weeks, with similar outcomes at 6 months. Patients with severe CTS, including objective weakness or sensory deficits, should be offered surgical decompression. Endoscopic and open carpal tunnel release techniques are equally effective.

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BACKGROUND Nonunion of a rib fracture can cause chronic pain, and pharmacological pain management may lead to medication dependence. This report describes a 54-year-old man with a chronic cough and painful nonunion fracture of the left posterior 8th rib, managed with minimally invasive surgery and a rib splint. CASE REPORT A 54-year-old man presented with chronic cough-induced left chest wall pain. Three-dimensional chest computed tomography (CT) scan showed a nonunion of a fracture of the left posterior 8th rib. After medical management failure, we proposed a surgical approach with the aim to remove the tissue comprising the nonunion, release the nerve, and stabilize the bone stumps. To avoid the adverse effects of a large incision, we designed a minimally invasive strategy based on ultrasound fracture localization and the use of an intramedullary splint. The pain disappeared immediately after surgery. The patient was discharged in 24 hours. At 6-week follow-up, he was still asymptomatic, and a new CT scan reconfirmed the correct splint position. From the immediate postoperative evaluation until the last follow-up visit, he consistently reported full satisfaction. CONCLUSIONS This report has highlighted the challenges of management of chronic pain in nonunion of a rib fracture, and has described the use of a minimally invasive surgical approach. In this single case, our tailored surgical strategy achieved definitive success in pain management, minimizing postoperative complications/adverse effects and avoiding the addition of pain medications despite a 24-hour hospital stay. Our goal is to share an alternative solution for colleagues facing similar cases.

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Aims: It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer the redisplacement of fewer fractures and better one-year outcomes compared with plaster splinting. Methods: In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure. Results: The study included 420 patients. There was no significant difference between the rate of redisplacement of the fracture between the groups: 47% (n = 88) for those treated with a plaster splint and 49% (n = 90) for those treated with a circumferential cast (odds ratio 1.05 (95% confidence interval (CI) 0.65 to 1.70); p = 0.854). Patients treated in a plaster splint reported significantly more pain than those treated with a circumferential cast, during the first week of treatment (estimated mean NRS 4.7 (95% CI 4.3 to 5.1) vs 4.1 (95% CI 3.7 to 4.4); p = 0.014). The rate of complaints relating to the cast, clinical outcomes and PROMs did not differ significantly between the groups (p > 0.05). Compartment syndrome did not occur. Conclusion: Circumferential casting did not result in a significantly different rate of redisplacement of the fracture compared with the use of a plaster splint. There were comparable outcomes in both groups.

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PURPOSE: Injuries to the upper extremity often result in stiffness. The joint capsule may lose its elastic properties, limiting motion. Most modalities for increasing motion are based on capsule stretching, and usually involve physical or occupational therapy. We tested the hypothesis that the Joint Active System static-progressive splint is helpful in increasing range of motion in stiff joints after failure of other treatments. METHODS: Candidates for the Joint Active System splint were mostly patients with upper extremity trauma that required surgery, if they plateaued after therapy but still had stiffness. A retrospective review was performed of all patients from 2015 to 2019 that met our inclusion criteria. Etiologies of stiffness and patient demographics were documented. Range of motion was recorded before and after treatment and, when available, functional scores were calculated. RESULTS: Forty-four patients were treated with the Joint Active System splint; 5 were excluded, leaving 39 for analysis: 15 elbow, 14 wrist and 10 proximal interphalangeal joints. All patients had received therapy before using the Joint Active System and 11 had tried a dynamic splint in addition to therapy. All joints showed significant improvement in motion after treatment: from 66.5° to 95.7° in the elbow, 63.5° to 81.1° in the wrist and 33.2° to 51.8° in the proximal interphalangeal joint. When functional scores were available before and after treatment, there was significant improvement for both elbow and wrist. Even when the Joint Active System was started many months after injury, it was effective. CONCLUSIONS: Despite reaching a plateau with therapy, the Joint Active System static-progressive splint is effective in improving range of motion in elbow, wrist and finger joints with stiffness following injury or surgery. TYPE OF STUDY: Retrospective case series. LEVEL OF EVIDENCE: Therapeutic, level IV.

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OBJECTIVE: To compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc. METHODS: This retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes. RESULTS: During the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B's mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A's mouth opening did not significantly improve. Regarding pain, Group A's VAS score decreased by 0.463 ± 0.778 after one month, and Group B's score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups. CONCLUSION: Compared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

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OBJECTIVE: Aim: To study the specifics of the impact of immediate intraoperative loading with a splinting component on supporting tissues during a one-stage implantation protocol. PATIENTS AND METHODS: Materials and Methods: In the course of the study, orthopedic treatment was carried out for 55 patients aged 29 to 60 years. The following were performed: cone-beam computed tomography, software planning and intraoral scanning with an optical scanner, one-stage implantation protocol, assessment of implant stability with the Osstell ISQ device, microcirculation study in the peri-implant area using laser Doppler flowmetry (LDF). RESULTS: Results: It was established that around loaded implants there is an increase in blood flow and vasomotor activity of the microcirculatory channel of the supporting tissues, an increase in the volume of bone tissue and an increase in torque, which is the optimal forecast for the acceleration of the pace of osseointegration. CONCLUSION: Conclusions: The use of a splinting component during immediate intraoperative functional masticatory load accelerates the dynamics of bone tissue remodeling processes around the implant, which is an optimal prediction of osseointegration rates in various dental implantation protocols and is consistent with high values of the implant stability coefficient.

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INTRODUCTION: Climate change is estimated to be the biggest global health threat of the 21st century, and has prompted calls to move away from processes in healthcare associated with high energy consumption and greenhouse gas emission. In musculoskeletal medicine, splints are widely used for limb immobilisation. These have typically been made from single-use materials such as gypsum, although in recent years purportedly environmentally friendly splints have been designed. In this systematic review, we set out to assess the clinical effectiveness of all commercially available environmentally friendly splinting materials, including Woodcast®. METHODS: The AMED (Allied and Complementary Medicine Database), CINAHL® (Cumulative Index to Nursing and Allied Health Literature), Cochrane Central Register of Controlled Trials, Embase®, Emcare® and MEDLINE® databases were searched to identify studies assessing the clinical effectiveness of biodegradable and environmentally friendly splints prior to paper review and data extraction. Formal quantitative synthesis was not possible owing to the substantial heterogeneity in the study designs and outcome measures. RESULTS: Six papers met the inclusion criteria, all investigating one particular splint material (Woodcast®). One was a case series, two were cohort studies and three were randomised controlled trials. Primary outcome measures were heterogeneous but the environmentally friendly splints were generally equivalent to traditional splint materials. Studies were mostly at a high risk of bias. CONCLUSIONS: There is limited research assessing 'green' splints in practice although the data suggest similarity with existing materials and no substantial safety concerns. Further scrutiny of the clinical effectiveness and environmental credentials of such splints is also required.

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PURPOSE: Ankle fracture-dislocations (AFD) often necessitate staged management involving temporary external fixation (EF) due to mechanical instability or blistering. However, limited literature exists on the optimal temporary immobilization method for low-energy closed AFD. This study compared baseline patient and fracture characteristics, along with clinical and radiological outcomes between AFD initially immobilized with EF versus splinting. METHODS: A retrospective cohort study was conducted involving patients with AFD temporarily immobilized using EF or splinting, followed by definitive open reduction and internal fixation. Quality of reduction (QOR) was assessed for each patient post-initial immobilization and after the definitive surgery. RESULTS: The study encompassed 194 patients: 138 treated with a splint (71.1%) and 56 (28.9%) with EF. Secondary loss of reduction had occurred in three patients who were splinted (2.2%). The mean ages in the EF and splint groups were 63.2 and 56.1 years, respectively (p = 0.01). Posterior malleolus fracture (PMF) and blisters were more prevalent in EF patients (69.6% vs. 43.5% for PMF and 76.8% vs. 20.3% for blisters, respectively; p = 0.05 and p < 0.01). Postoperative complication rates were 8.9% for EF versus 10.9% for splinting (p = 0.69). Satisfactory final QOR was attained in 79.8% of patients treated with a splint versus 64.3% with EF (p = 0.02). CONCLUSION: Patients immobilized by EF presented with poorer baseline characteristics and had more unstable injuries. Nevertheless, postoperative complication rates were comparable. Thus, EF appears to be a valuable tool for standardizing outcomes in AFD patients with a less favorable prognosis.

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This study aimed to investigate the bisphenol A (BPA) release from four CAD/CAM splint materials: three polycarbonate-based (DD BioSplint C, Splint Plus Biostar, Temp Premium Flexible) and one polymethylmethacrylate-based (Temp Basic) material. From each material, ten cylindrical samples (n = 40) were immersed in high-performance liquid chromatography (HPLC) grade water following ISO 10993-12 and incubated for 24 h in an incubation shaker at 37°C and 112 rpm. Following BPA derivatization, analysis was performed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). After 24 h of incubation, all investigated materials released significant amounts of BPA compared to water blanks. The material-dependent elution increased in the following order: DD BioSplint C < Splint Plus Biostar < Temp Basic < Temp Premium Flexible. Subtracting extraneous BPA, the concentrations ranged between 2.27 ng/mL and 12.65 ng/mL. After extrapolating the concentrations in relation to the average surface area of occlusal splints, the amount of BPA per mL exceeded the Tolerable Daily Intake (TDI) set by the European Union for a person weighing 70 kg by 1.32-6.16 times. Contrary to the release from previously investigated materials, BPA elution from CAD/CAM splint materials was highly elevated. Considering the increasing adaptation of CAD/CAM techniques, elution from them may represent a relevant BPA source in daily dental practice.

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