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Silvio Tocco, B.Sc. in Occ. Th. & Biology
Occupational Therapist, Hand Therapy Specialist
Studio Terapico Kaiser (Parma) www.studiokaiser.com
Honorary Secretary for the Council of OT in the European Comunity (C.O.T.E.C.) www.cotec-europe.org
Member of the Italian OT Associazione council (A.I.T.O.) www.aito.it
Affiliated Professor and Clinical Placement Coordinator for Modena and Reggio-Emilia University
Serial Casting for PIP Joint Flexion Contractures: A Retrospective Study
Tocco, S.
Background:: No reports on serial casting of finger stiffness have been found in the recent literature.
Aim: To present preliminary results of conservative treatment for chronic PIPj flexion contractures with the serial casting technique.
Methods: A review was done of 24 patients (15 males) treated between June 2004 and July 2007. Exclusion criteria: articular damage, previous surgery to digit, known arthritis, underlying disease. Inclusion criteria: Time from injury more≥5wks, Active PIPj extension deficit≥15°. All patients were evaluated and treated by the same therapist in a single clinical setting. Quickcast™ finishing tape was used as the casting material from day 1 until PIPj passive extension reached a plateau (mean time for maximum correction was 6 days (range 0-22). The cast was then replaced with a thermoplastic cylinder splint for a mean wear of 29 days (range 15-54) of continuous immobilization
Results: Mean delay from injury was 113 days (range 34-365). Mean treatment duration was 79 days (range 41-172). Mean number of visits was 9 (range 4-26). At baseline, mean active PIPj extension deficit was 33,3° (range 15° to 55°), and mean TAM was 212 ° (range 155° to 290°). At the end of treatment, mean active PIPj extension deficit was 6,7° (range 0° to 30°), and mean TAM was 224° (range 175° to 260°). Subjects are presently being recalled for their long-term follow-up. These results will be presented.
Conclusion: According to this review, PIPj active extension recovery is possible through serial casting for undamaged stiff joints within a reasonable time frame. However, long-term outcomes are under investigation. Further studies are needed to evaluate serial casting effectiveness over other conservative treatments and its global cost-effectiveness versus surgical approach.