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Night-Time Splinting After Fasciectomy or Dermofasciectomy for Dupuytren’s Contracture: A Pragmatic, Multi-centre, Randomised Controlled Trial

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Dupuytren’s Disease and Related Hyperproliferative Disorders

Abstract

Background Dupuytren’s disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting; however the evidence supporting night splinting is of low quality and equivocal.Methods A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. A total of 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77) or hand therapy with night splinting (n = 77). Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat.Results A total of 148 (96%) patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0–100 scale: adjusted mean diff. 0.66, 95%CI −2.79 to 4.11, p = 0.703), total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI −2.33 to 12.55, p = 0.172) or patient satisfaction (0–10 numerical rating scale: adjusted mean diff −0.35, 95%CI −1.04 to 0.34, p = 0.315) at 1 year post surgery. Similarly, in a secondary per-protocol analysis, no statistically significant differences were observed between the groups in any of the outcomes.Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists’ time, thermoplastic materials and the potential inconvenience to patients having to wear a device, the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur.Trial Registration The trial was registered as an International Standard Randomised Controlled Trial ISRCTN57.7.6.4.41.1

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Editorial Statements

Competing Interests

The authors declare that they have no competing interests.

Authors’ Contributions

CJH, LS, AJC and DL all contributed to the trial concept and design, interpretation of data and drafting of the manuscript. LS undertook the statistical analysis. EB and SV conducted all data collection. CJH, LS, AJC and DL obtained funding. All authors revised the manuscript for important intellectual content and have read and approved the final version.

Acknowledgements

Action Medical Research Charity funded the trial costs including all consumables and research associate salaries (AP1074). CJH and LS were funded by the Faculty of Health, University of East Anglia. The National Institute for Health Research (NIHR) funded CJH through a Career Development Fellowship from January 2009. The study received support by NIHR through the Comprehensive Local Research Network.

The SCoRD Trial Group included:

Investigators: C Jerosch-Herold, L Shepstone, A Chojnowski, D Larson.

Surgeons and sites: P Chapman, A Chojnowski, A Logan, M Meyer, A Patel (Norwich); G Cormack, J Hopkinson-Woolley, I Grant (Cambridge); M Wood (Bury St Edmunds); J Jones, A White, A Doran (Peterborough); P Crossman, C Roberts, M Shanahan (Ipswich). Lead Hand Therapists and sites: D Larson (Norwich), M Hayden (Cambridge); Laura Smith (Bury St Edmunds); Jill Frusher (Peterborough), J Dinley (Ipswich). Trial research staff: E Barrett, S Vaughan. Independent Trial Steering Committee members: DGI Scott, S Spooner. Local PPIRes members: C Handford, V Hawes, C Williams.

Previous Publication

This chapter has been published first in BMC Musculoskeletal Disorders 2011, 12:136doi:10.1186/1471-2474-12-136. It is re-printed in a slightly modified form and with permission by the authors.

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK

    Christina Jerosch-Herold, Lee Shepstone, Elisabeth Barrett & Susan P. Vaughan

  2. Department of Orthopaedics and Trauma, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

    Adrian J. Chojnowski

  3. Department of Occupational Therapy, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

    Debbie Larson

Authors
  1. Christina Jerosch-Herold
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  2. Lee Shepstone
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  3. Adrian J. Chojnowski
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  4. Debbie Larson
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  5. Elisabeth Barrett
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  6. Susan P. Vaughan
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Corresponding author

Correspondence to Adrian J. Chojnowski .

Editor information

Editors and Affiliations

  1. The Hand Center, S Old Dixie Highway 1002, Jupiter, 33458, Florida, USA

    Charles Eaton

  2. Strahlenzentrum Hamburg, Langenhorner Chaussee 369, Hamburg, 22419, Germany

    M. Heinrich Seegenschmiedt

  3. Manchester Interdisciplinary Biocentre, Plastic & Reconstructive Surgery, University of Manchester, Princess Street 131, Manchester, M1 7DN, United Kingdom

    Ardeshir Bayat

  4. Faculty of Medicine, Dept. of Pathology and Immunology, University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland

    Giulio Gabbiani

  5. Medical Center, Department of Plastic Surgery, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands

    Paul Werker

  6. Dupuytren e.V., Westerbuchberg 60b, Übersee, 83236, Germany

    Wolfgang Wach

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Jerosch-Herold, C., Shepstone, L., Chojnowski, A.J., Larson, D., Barrett, E., Vaughan, S.P. (2012). Night-Time Splinting After Fasciectomy or Dermofasciectomy for Dupuytren’s Contracture: A Pragmatic, Multi-centre, Randomised Controlled Trial. In: Eaton, C., Seegenschmiedt, M., Bayat, A., Gabbiani, G., Werker, P., Wach, W. (eds) Dupuytren’s Disease and Related Hyperproliferative Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-22697-7_41

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  • DOI: https://doi.org/10.1007/978-3-642-22697-7_41

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  • Online ISBN: 978-3-642-22697-7

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