Pre-Operative Serial Casting for Dupuytren’s Contracture Involving the PIP Joint,
Clinical Pearl No. 2 – October 2008

HandLab Clinical Pearls

October 2008                               No. 2

 PRE-OPERATIVE SERIAL CASTING FOR DUPUYTREN’S CONTRACTURE INVOLVING THE PIP JOINT

 

It is well know that the outcome following Dupuytren’s fasciectomy is often poor when surgical release of a severe PIP joint flexion contracture must also occur. Pre-operative serial casting of the PIP joint prior to fasciectomy, however, can make the surgical excision of the Dupuytren’s easier and improve the final outcome. (Dupuytren’s contracture will respond to serial casting/splinting, but one cannot expect permanent change; when the casting/splinting is discontinued the contracture recurs.) Surgeons I have worked with describe easier excision of the fascial bands because of diminished convolution, having enough skin length to avoid the need for a skin graft, and a reprieve from performing a capsulotomy.

If there is disruption of the tendon due to a mallet injury, tension potentially causes a “gap” to form between the healing tendon ends.CP2-1Dupuytren’s: Combined MP and PIP joint flexion contractures are ideal for pre-operative serial casting.

You may want to discuss the possibility of preoperative serial casting with your referring surgeon for those patients with Dupuytren’s contracture who have PIP joint flexion contractures. Your surgeon will appreciate the fact that pre-operative therapy can make the surgery technically easier!!!CP2-3

 

CP2-2First step is a volar plaster slab across all joints, reinforced with either a small piece of thermoplastic material or a small longitudinal roll of plaster of Paris.Final step is wrapping plaster of Paris around the entire finger to hold the volar slab in place so both joints are held at easy maximum extension.

Download Clinical Pearl No. 2, Pre-Operative Serial Casting for Dupuytren’s Contracture Involving the PIP Joint, October 2008

ADDITIONAL SUGGESTED READING

Clinical Pearl No. 30 – Should all Orthoses be 2/3 the Length of the Forearm?

Clinical Pearl No. 26 – Use of a Relative Motion Orthosis for Regaining PIP Joint Flexion or Extension

Clinical Pearl No. 14 – How Long Should I Serial Cast a Finger?

Clinical Pearl No. 13 – Why I Dislike Ulnar/Radial Gutter Splints!!

Clinical Pearl No. 12 – Why I Avoid Passive Flexion of the DIP Joint

Clinical Pearl No. 7 – Attaching Interface Mold to Splint Surface

Clinical Pearl No. 5 – “Splint” Suggestion for the Hypermobile Wrist

Clinical Pearl No. 4 – Leather, The Forgotten Strapping Material

Clinical Pearl No. 2 – Pre-Operative Serial Casting for Dupuytren’s Contracture Involving the PIP Joint

Book Chapter – Therapist’s Management of the Stiff Hand, Rehabilitation of the Hand and Upper Extremity – 2011

Book Chapter – Principals of Splinting and Splint Prescription, Surgery of the Hand and Upper Extremity – 1996

Book Chapter – Spring-Wire Extension Splinting of the Proximal Interphalangeal Joint, Rehabilitation of the Hand – 1995

Journal Article – Plaster of Paris: The Forgotten Hand Splinting Material, Journal of Hand Therapy – 2002

Journal Article – Efficient Mechanics of PIP Mobilisation Splinting, British Journal of Hand Therapy – 2000

Journal Article – Modification of the Digital Serial Plaster Casting Technique by Colditz, JC and Schneider AM, Journal of Hand Therapy – 1995

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Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.