This study aims at investigating if splinting and early mobilization is a better method, regarding range of motion, for treating fractures of the base phalanx of the fingers compared to surgery with pinning. This will be achieved through a randomised clinical trial comparing the two methods.
Proximal phalangeal fractures of the hand are very common and affect patients of all ages. . Most fractures heal without complications but these injuries can result in impaired hand function and prolonged inability to work and perform activities of daily living. If there is a dislocation that cannot easily be repositioned to a stable position, surgery might be required. Surgery is often performed with percutaneous pinning and immobilisation in plaster for 4 weeks. Good results of non-surgical treatment with a splint that allows immediate mobilization of the interphalangeal joints has been reported. This study will compare these two methods for treating fractures of the base phalanx of the fingers. Recruited patients will be randomized to one of the two treatment arms: 1. surgery with pinning 2. conservative treatment with a splint. Primary outcome is total active range of motion in the affected finger at 3, 6 months and 1 , 3 years. Secondary outcomes are number of sick days and various patient related outcome measures.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
Closed reduction, percutaneous pinning and plaster
Closed reduction, custom made orthosis and early mobilization
Dept Hand Surgery
Stockholm, Sweden
RECRUITINGTAM (Total active range of motion)
Total active range of motion measured in degrees of the affected finger.
Time frame: 3 months
TAM (Total active range of motion)
Total active range of motion measured in degrees of the affected finger.
Time frame: 6 months
TAM (Total active range of motion)
Total active range of motion measured in degrees of the affected finger.
Time frame: 1 year
TAM (Total active range of motion)
Total active range of motion measured in degrees of the affected finger.
Time frame: 3 years
Number of sick days
Number of sick days from the intervention until full return to work.
Time frame: 3 months
Patient related outcome measure DASH
Disability of the Arm, Shoulder and Hand score (DASH). 0 points means no disability and 100 maximum disability.
Time frame: 3, 6 months and 1 and 3 years
Patient related outcome measure HADS
Hospital Anxiety and Depression Scale (HADS). The score is consists of one depression scale from 0 to 21, where 0 is no signs of depression and one anxiety scale from 0 to 21, where 0 means no anxiety.
Time frame: 3, 6 months and 1 and 3 years
Patient related outcome measure EQ-5D
EuroQols quality of life index. Consists of an index based on the questionnaire where 0 means death and 1 means full quality of life and one visual analog scale 0-100 where patients rate their health from bad (0) to excellent (100).
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Time frame: 3, 6 months and 1 and 3 years
Patient related outcome measure HQ-8
HQ-8 is a questionnaire specifically for hand injuries. Each question gives a score 0-100, where 0 means no problems and 100 means worst imaginable problem.
Time frame: 3, 6 months and 1 and 3 years
Grips strength
Measured in kilograms (JAMAR)
Time frame: 3, 6 months and 1 and 3 years