Plaster may be equivalent to functional splints in gamekeepers thumb
- Report By: Steve Jones - Specialist Registrar
- Search checked by Ian Crawford - Clinical Research Fellow
- Institution: Manchester Royal Infirmary
- Current web editor: Bob Phillips - Section Editor, Archimedes
- Date Submitted: 8th April 2002
- Date Completed: 7th November 2002
- Last Modified: 13th November 2002
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Status:
Green (complete)
Three Part Question
In a [rupture of the ulnar collateral ligament of the thumb] is [plaster immobilisation better than functional splintage of spica] at [reducing instability, arthrosis and pain]?Clinical Scenario
A young poacher comes into the Emergency Department complaining of a sore thumb after a night pilaging the local squire's estate. He smells strongly of game birds and clinically he has a rupture of the ulnar collateral ligament of his thumb. You wonder whether to plaster him or place him in a functional splint in the first instance?Search Strategy
Medline 1966-04/02 using the OVID interface.[{(exp Collateral ligaments OR exp ligaments OR exp ligaments, articular OR ligament$.af) AND (exp Thumb OR thumb.af)} OR (gamekeeper$.af OR skier$.af)] AND [exp Immobilization OR exp Casts, surgical OR exp Splints OR plaster.af OR splint.af OR spica.af] LIMIT to human AND English.
Search Outcome
50 papers were found of which only 1 was of sufficient quality for inclusion.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Sollerman C et al, 1991, Denmark | Total of 63 patients with acute injuries 23 patients had surgical repair (10 in casts vs 13 in splints) 40 did not require surgical repair (21 in casts vs 19 in splints) | PRCT | Stablity Range of motion Strength Length of sick leave Patient preference | At the follow-up examination after 15 (11-41) months, there was no difference between the treatment groups as regards any of the outcomes |
Comment(s)
In this single study immobilization of the thumb with a moveable splint was strongly preferred by the patients and the functional results of this technique were equal to plaster cast immobilization after both surgical and nonsurgical treatment.Clinical Bottom Line
Functional splintage should be used in this group of patients rather than plaster casts.Level of Evidence
Level 3 - Small numbers of small studies or great heterogeneity or very different population.References
- Sollerman C, Abrahamsson SO, Lundborg G et al. Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. A prospective randomized study of 63 cases. Acta Orthopaedica Scandinavica 1991;62(6):524-6.