Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review

Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords “developmental dysplasia hip”, “brace”, “harness”, “splint”, “abduction brace” to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4–5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.

Gradual distraction for treatment of severe knee flexion contractures using the Ilizarov’s apparatus

<p class="abstract"><strong>Background:</strong> Knee flexion contractures result in a significant amount of functional disability due to reduced mobility and limb length discrepancy. Treatment options include non-surgical methods like serial casting, dynamic splinting and traction or surgical methods like osteotomies and soft tissue procedures. External fixation has emerged as a highly successful means of achieving controlled gradual correction of joint contractures with low rates of complications including recurrence. The aim of this study is to evaluate the functional outcome in terms of residual deformity and change in ambulatory status following correction using the Ilizarov’s apparatus.</p><p class="abstract"><strong>Methods:</strong> 12 patients with knee flexion contractures ranging from 20°-70° underwent correction using the Ilizarov’s external fixator (IEF). The use of simple mathematic formulae enabled us to calculate and estimate the rate and duration of distraction. End results were assessed at one year by the residual contracture as: Excellent: 0-5°, Good: 6-15°, Fair: 16-30° and Poor: &gt;30°.<strong></strong></p><p class="abstract"><strong>Results:</strong> The functional assessment was graded as excellent in 7, good in 4 and fair in 1 out of 12 patients. All patients were independent ambulators and only 1 out of 12 patients required an additional orthosis for maintenance of the correction.</p><p><strong>Conclusions:</strong> The IEF is a safe and precise modality even for the most complex contractures of the knee. Accurate placement of the hinges along the center of rotation of the knee avoids undue subluxation of the tibia during correction. In order to ensure a low rate of complications, it is imperative to have a detailed pre-operative plan and all principles of fixation should be meticulously adhered to. </p>

Bone and joint injuries of the hand

The small bones and joints of the hand are vulnerable to fracture and dislocation. These same structures need to be pain-free, stable, and mobile for proper function. Careful diagnosis and meticulous management is required. This may entail early mobilization (e.g. a metacarpal neck fracture) or temporary splinting (e.g. mallet fracture), early repair (e.g. unstable thumb ulnar collateral avulsion), complex sequential and dynamic splinting (e.g. central slip rupture); percutaneous wires (e.g. Bennett’s fracture) or plate fixation (e.g. displaced index metacarpal shaft). There is often a trade-off between the mobilization required to avoid stiffness and the immobilization required to allow anatomical healing. Rigid surgical fixation with meticulous hand therapy may both contribute in certain patients.

The “Sparti” splint for rehabilitation of extensor tendon injuries in zones V-VII

Dynamic splinting is a well-known method for maintaining finger movement after ruptures of the extensor tendons. We describe a simple, inexpensive and easy-to-construct modification of a dynamic splint, called the “Sparti” splint, suitable for a six-week period of rehabilitation of injured extensor tendons in zones V-VII.