A modified spica-splint in postoperative early-motion management of skier's thumb lesion: A randomized clinical trial

Background. Rupture of ulnar collateral ligament of the thumb (UCL) represents a frequent injury of the hand. Surgical repair is considered the gold standard but postoperative immobilization causes partial stiffness in a percentage of cases. Aim. The aim of this paper was to assess the effectiveness of a postoperative functional hand-based splint for the thumb which allows immediate postoperative motion. Design. Randomized prospective clinical trial. Setting. The study was carried out at the Orthopedics and Hand Surgery Unit of The Catholic University School of Medicine, Rome, Italy. Population. Thirty consecutive patients, with a diagnosis of acute complete tear of the UCL, were selected to be treated surgically (predominantly men, mean age 39). Cases presenting associated injuries were not included. Methods. Patients were randomized postoperatively into 2 groups of 15 (one using the new splint and the other using a standard spica splint). After four weeks of splinting, clinical outpatient evaluations were carried on (at one, two, six, twelve months) on both groups to evaluate: joint stability; pain; pinch strength; range of motion; time lost from work; sessions of physiotherapy. Results. Immediate postoperative motion of the operated joint produced faster and better functional results. No cases of recurrence were recorded. Conclusions. Surgical repair, combined with active metacarpophalangeal motion allowed by the new functional splint, was effective, safe and well tolerated. Clinical rehabilitation impact. Enhancing the pa tients' function and reducing the time of functional recovery, the reported treatment presents potential advantages in the management of this frequent acute hand injury.