Plaster may be equivalent to functional splints in gamekeepers thumb
Date First Published:
April 8, 2002
Last Updated:
November 13, 2002
Report by:
Steve Jones, Specialist Registrar (Manchester Royal Infirmary)
Search checked by:
Ian Crawford, Manchester Royal Infirmary
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.
Search Details:
[{(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.
Outcome:
50 papers were found of which only 1 was of sufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. A prospective randomized study of 63 cases. Sollerman C, Abrahamsson SO, Lundborg G 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<br><br>Range of motion<br><br>Strength<br><br>Length of sick leave<br><br>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 |
Author Commentary:
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.
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.