UNASSIGNED: We have used ultrasound imaging technology to objectively demonstrate changes in the degree and quality of diseased fascia in patients with Dupuytren\'s disease treated nonoperatively with therapeutic splinting and tissue mobilization.
UNASSIGNED: Measurement of active proximal interphalangeal and metacarpophalangeal joint extension along with ultrasound elastography imaging of the fascia was performed prior to, and 6 months after, the initiation of therapy.
UNASSIGNED: Improvement in active joint extension over the course of therapy was associated with a consistent decrease in the radiologic dimensions of the diseased fascia in combination with qualitative changes in its composition.
UNASSIGNED: The use of a simple orthosis and soft tissue mobilization techniques have a quantifiable effect on the degree of deformity and the quantity and quality of contracted fascia in Dupuytren\'s disease, and would appear to have a role in the management of mild to moderate presentations of the disease when enzymatic or surgical interventions may not be practical.

External nasal splints are commonly used for immobilization following nasal fracture reduction or rhinoplasty procedures. The literature documents the use of various materials like thermoplastic materials, aluminum, Orthoplast, fiberglass, plaster of Paris, and polyvinyl siloxane. These materials are bulky, time-consuming, expensive, and cumbersome to use, and have been associated with complications including contact dermatitis and epidermolysis. Furthermore, they cannot be retained if the situation warrants prolonged stabilization and immobilization. We introduce a new technique using readily available scalp vein catheter flanges as an external nasal stent. The technique is easy to master, inexpensive, and limits edema and ecchymosis, while stabilizing the reconstructed nasal skeleton in position during the healing period.

BACKGROUND: Without surgical repair, flexor tendon injuries do not heal and patients\' ability to bend fingers and grip objects is impaired. However, flexor tendon repair surgery also requires optimal rehabilitation. There are currently three custom-made splints used in the rehabilitation of zone I/II flexor tendon repairs, each with different assumed harm/benefit profiles: the dorsal forearm and hand-based splint (long), the Manchester short splint (short), and the relative motion flexion splint (mini). There is, however, no robust evidence as to which splint, if any, is most clinical or cost effective. The Flexor Injury Rehabilitation Splint Trial (FIRST) was designed to address this evidence gap.
METHODS: FIRST is a parallel group, superiority, analyst-blind, multi-centre, individual participant-randomised controlled trial. Participants will be assigned 1:1:1 to receive either the long, short, or mini splint. We aim to recruit 429 participants undergoing rehabilitation following zone I/II flexor tendon repair surgery. Potential participants will initially be identified prior to surgery, in NHS hand clinics across the UK, and consented and randomised at their splint fitting appointment post-surgery. The primary outcome will be the mean post-randomisation score on the patient-reported wrist and hand evaluation measure (PRWHE), assessed at 6, 12, 26, and 52 weeks post randomisation. Secondary outcome measures include blinded grip strength and active range of movement (AROM) assessments, adverse events, adherence to the splinting protocol (measured via temperature sensors inserted into the splints), quality of life assessment, and further patient-reported outcomes. An economic evaluation will assess the cost-effectiveness of each splint, and a qualitative sub-study will evaluate participants\' preferences for, and experiences of wearing, the splints. Furthermore, a mediation analysis will determine the relationship between patient preferences, splint adherence, and splint effectiveness.
CONCLUSIONS: FIRST will compare the three splints with respect to clinical efficacy, complications, quality of life and cost-effectiveness. FIRST is a pragmatic trial which will recruit from 26 NHS sites to allow findings to be generalisable to current clinical practice in the UK. It will also provide significant insights into patient experiences of splint wear and how adherence to splinting may impact outcomes.
BACKGROUND: ISRCTN: 10236011.

BACKGROUND: There is a controversy on the effectiveness of post-operating splinting in patients with carpal tunnel release (CTR) surgery. This study aimed to systematically evaluate various outcomes regarding the effectiveness of post-operating splinting in CTR surgery.
METHODS: Multiple databases, including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, were searched for terms related to carpal tunnel syndrome. A total of eight studies involving 596 patients were included in this meta-analysis. The quality of studies was evaluated, and their risk of bias was calculated using the methodological index for non-randomized studies (MINORS) and Cochrane\'s collaboration tool for assessing the risk of bias in randomized controlled trials. Data including the visual analogue scale (VAS), pinch strength, grip strength, two-point discrimination, symptom severity score (SSS), and functional status scale (FSS) were extracted.
RESULTS: Our analysis showed no significant differences between the splinted and non-splinted groups based on the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. The calculated values of the standardized mean difference (SMD) or the weighted mean difference (WMD) and a 95% confidence interval (CI) for different variables were as follows: VAS [SMD = 0.004, 95% CI (-0.214, 0.222)], pinch strength [WMD = 1.061, 95% CI (-0.559, 2.681)], grip strength [SMD = 0.178, 95% CI (-0.014, 0.369)], SSS [WMD = 0.026, 95% CI (- 0.191, 0.242)], FSS [SMD = 0.089, 95% CI (-0.092, 0.269)], and the two-point discrimination [SMD = 0.557, 95% CI (-0.140, 1.253)].
CONCLUSIONS: Our findings revealed no statistically significant differences between the splinted and non-splinted groups in terms of the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. These results indicate that there is no substantial evidence supporting a significant advantage of post-operative splinting after CTR.

OBJECTIVE: The recommendations for splinting are well established for the injuries of permanent dentition; however, ambiguity still exists for the injuries in primary dentition. Hence, this study aimed to determine the most appropriate dimensions of stainless steel wire and its extent, for achieving the physiologic mobility in primary dentition.
METHODS: This study was designed as an in vitro experiment by using a typodont model of primary dentition. The baseline mobility of primary maxillary incisors was calibrated to the physiologic mobility of natural primary incisors by using a Teflon tape wrapped around the roots of resin teeth. Splinting was done using a stainless steel wire of 0.2 mm (Group I), 0.3 mm (Group II), and 0.4 mm (Group III). These groups were subdivided (a, b, and c) on the basis of the extent of the splint, and pre splint mobility (Pre-PV) and post-splint mobility (Post-PV) were tested by Periotest M. The splint effect was calculated by subtracting Post-PVs and Pre-PVs.
RESULTS: The normal values of mobility in healthy human volunteers ranged from 10.5 to 13. The overall splint effect was higher in Group III irrespective of the extent of the splint, whereas it was found to be the lowest in Group I (b and c). The splint effect increased with the extent of the splint in all the groups. Among all the groups, the splint effect on the anchor teeth was observed to increase with the extent of the splint and the diameter of the wire.
CONCLUSIONS: The mobility of the injured and anchor teeth splinted with 0.2-mm stainless steel wire was similar to the pre-splint and physiologic mobility. The most favorable extension was one tooth adjacent to the injured tooth on each side for both 0.2- and 0.3-mm wires.

Palmar burn injuries are common in young children and can result in contracture.
A prospective longitudinal study describes outcomes of palm and digit extension splint use following burn in 75 children (83 hands) aged < 5 years and determines whether specific cutaneous functional units (CFUs) are associated with early signs of contracture (ESC). Outcomes were assessed up to 9-18 months following burn. Routine clinical data was collected at therapy reviews.
Children were splinted > 12 h/day for a mean of 158 days following burn. The mean time to splint cessation was 264 days following burn. Fourteen hands developed ESC (17%): 12 hands had full ROM restored following conservative management, 2 hands (3%) progressed to contracture. Hands that developed ESC had greater healing time (p = 0.002), greater number of CFUs affected (p < 0.001), and greater number of immediate first webspace and extended first webspace CFUs affected (p = 0.002, p < 0.001 respectively). ESC risk increases for each day to heal (odds ratio [OR] 1.1, 95% CI 1.0-1.2) and each CFU in extended first webspace (OR 2.8, 95% CI 1.5-5.0).
Early and intensive splinting following palmar burn results in excellent ROM. Burns involving more CFUs or the first webspace are associated with ESC.

Radicular cysts are the most common cystic lesions that affect the jaws, which, though mostly asymptomatic, can be seen radiographically as an oval or pear-shaped unilocular radiolucency in the periapical region. Nonsurgical root canal procedures and periapical surgery followed by placement of bone substitute and bioceramic root-end filling material is generally the treatment of choice. This case report highlights the endosurgical management of long-standing trauma that led to a radicular cyst with respect to three maxillary anterior teeth in a young adult. The clinical and radiographic examination led to a provisional diagnosis of a radicular cyst, which was confirmed by biopsy. Non-surgical root canal treatment was performed with Mineral Trioxide Aggregate (MTA) as the apical barrier and surgical enucleation of the cyst was performed followed by placement of hydroxyapatite bone graft. Follow-ups till two years were done, which revealed the successful management of the case.

Traumatic dental injuries (TDIs) are a relatively frequent occurrence, with roughly a third of adults experiencing a dental trauma at some time in their life.1 TDIs may present to dental professionals working within primary or secondary care settings. Patients presenting at the time of acute injury will require immediate management and careful long term follow up. Patients may also present later reporting a history of TDI, with developing complications and onward management required. To support dental care professionals, the International Association of Dental Traumatology\'s (IADT) Guidelines are available globally as a standardised tool to aid the assessment, management and follow up of dental trauma. These easy to access guidelines were updated in 2020 with four distinct publications:General Introduction,1 Fractures and Luxations,2 Avulsion of Permanent Teeth,3 and Injuries in the Primary Dentition.4 The current guidelines represent the best evidence based on available literature and expert opinion.1This paper aims to support dental professionals by specifically highlighting and describing updates in guidance, using the 2020 IADT published guidelines. By incorporating the 2020 guidelines into our everyday practice we aim to provide the most appropriate, standardised care, based on the highest level of available evidence to our patients.The full published guidelines are available free online via the IADT website.

Avulsion injuries, though relatively uncommon, are one of the most serious of dentoalveolar injuries. Replantation at the scene of the incident is almost always the treatment of choice whenever possible. This paper outlines a step-by-step approach for the management of avulsion injuries, including a splinting protocol. This aims to support general dental practitioners in feeling more confident with managing these injuries.

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