REVIEW  DUPUYTREN 

Minerva Orthopedics 2023 December;74(6):514-27

DOI: 10.23736/S2784-8469.23.04336-5

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Effectiveness of static splinting in Dupuytren’s disease

Chiara MARINELLI ¹ ✉, Ilaria SAROGLIA ²

¹ Center for Rehabilitative Medicine “Sport and Anatomy,” University of Pisa, Pisa, Italy; ² Private Practitioner, Grosseto, Italy

INTRODUCTION: Dupuytren’s disease (DD) is a benign fibroproliferative disorder of the hand characterized by progressive and permanent contracture of the palmar fascia, which, if left untreated, causes irreducible flexion of one or more fingers. There are various procedures that can be performed to treat Dupuytren’s contracture, including surgical interventions such as fasciectomy, dermofasciotomy, percutaneous needle fasciotomy (PNF), pharmacological interventions with the use of collagenase injections, and more conservative treatments. To date, recommendations for the use of static extension splints found in the literature appear to be highly discordant, both in terms of splint design and intervention dosage.
EVIDENCE ACQUISITION: Despite the numerous rehabilitation techniques used in the treatment of DD, it is not entirely clear whether the use of static splints can have any significant efficacy in rehabilitative treatment, and especially whether the results obtained through such aid are prolonged over time. This scoping review aimed to review the existing scientific literature regarding the use and efficacy of static extension splints as a therapeutic strategy in treating DD. Specifically, we will analyze the use of splints as a rehabilitative tool in a conservative or preoperative treatment context, as a post-surgical therapeutic modality, and as support after collagenase injection to identify the correct rehabilitation protocol and assist the hand therapist towards evidence-based clinical practice. Article selection includes publication from 2012 to 2022, made on a population of adult subjects diagnosed with DD, and subsequent specialist rehabilitation treatment using a custom-made static splint using thermo-moldable material. The evaluation of the effectiveness of splint use was determined by measuring the total active extension (TAE) outcome. The search was conducted without language restriction for publication. However, studies whose abstracts and full-texts were not retrievable were excluded. The search for papers was conducted until December 2022 and was carried out on the electronic database of Medline via PubMed, PeDro and Cochrane. In addition, following a preliminary search, the most relevant key words were identified by consulting generic articles related to the subject. The results obtained from the research were evaluated independently by two researchers, following the eligibility criteria previously described. A first screening was carried out through the reading of the title and abstract. If the abstract of an article was considered interesting and in line with the “PICO” defined within the review, then the full-text was retrieved and read to assess its possible eligibility. Finally, a reporting of the search strategy was performed through a flow chart, in which the included articles and the reasons for the exclusion of those discarded were reported.
EVIDENCE SYNTHESIS: Fourteen articles meeting the eligibility criteria were included, including 2 systematic reviews, 4 RCT studies, 3 retrospective studies, 1 therapeutic study, 1 cross-sectional study, 1 observational study, and 3 case series. A flow chart was created to describe the phases of the research process, while the content of the individual articles was summarized in a synoptic table.
CONCLUSIONS: From the analysis of the studies reported, we can affirm that there is great heterogeneity in the literature regarding the protocols for the use of static splints employed in the treatment of DD. From the majority of the studies identified in our research, we can state that the use of static splints combined or not with specific therapy does not significantly improve TAE, as well as ROM and DASH scores. In conclusion, from the analysis of the results obtained from this review, it is possible to affirm that future studies are desirable to critically define the role of the splint in a wider population and with a more heterogeneous clinical representation. There is, therefore, a need to conduct further high-quality studies, in order to standardize future outcome measures and conclude on a gold-standard treatment protocol.

KEY WORDS: Dupuytren contracture; Splints; Orthopedics