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Compare the Effect of Gutter Splint and Capener Splint on PIP Joint Flexion Contracture: A Comparative Study

Dr Jagmohan Lal Meena*, Dr (Mrs) Snehal P Desai and Dr. Stephen B.A.Sams

Department of Occupational Therapy, RRU/107, ACTREC, Tata Memorial Centre, Navi Mumbai, India – 410210

ORCID: https://orcid.org/0009-0003-4782-3506

 

*Corresponding author

*Jagmohan Lal Meena, Department of Occupational Therapy, RRU/107, ACTREC, Tata Memorial Centre, Navi Mumbai, India – 410210

Abstract

PIP Flexion contracture is a common complication following hand injuries and conditions. Hand splinting is an integral part of therapy intervention. Either gutter or capener splint can be given for the correction of PIP joint flexion contracture. Gutter splint is a serial static splint whereas capener splint is a dynamic splint. A sample of 20 subjects with PIP flexion contracture participated in the study and were randomly selected for control and experimental groups. Control group had received Gutter splint whereas Capener splint was given in Experimental group for the period of 12 weeks. The study concluded that Capener splint is more effective than gutter splint for correction of PIP joint flexion contracture.

Keywords: PIP Flexion Contracture, Gutter Splint, Capner Splint, Hand Injuries, Hand function, Hand Splinting, Hand Therapy

Introduction

PIP Flexion contracture is a common complication following hand injuries and conditions [1]. It most frequently results from direct trauma to structures of the PIP joint, chronic edema, incorrect early positioning (Watson, 1982), crush injury, chronic synovitis at the PIP joint, destruction of the central slip of extensor tendon, adhesions of superficialis or profundus tendon, and post-burns contracture [2]. Hand splinting is an integral part of therapy intervention. Hand therapists can design a variety of splints, out of which either gutter or capener splint can be given for the correction of PIP joint flexion contracture. Gutter splint is a serial static splint and capener splint is a dynamic splint.

Review of Literature

Prosser R [1] studied the effect of capener splint on PIP joint flexion contracture and concluded that it was an effective treatment. Li C [3] conducted a biomechanical analysis of finger splints and concluded that capener splint is more effective than gutter splint in correcting PIP flexion contracture. Cecillia [4] studied the effect of corrective splinting on PIP flexion contracture of rheumatoid fingers and found significant improvement not only in correction of contracture but also in grip strength and JHFT scores.

Methodology

Hypothesis: Capener splint will be more beneficial compared to gutter splint in PIP flexion contracture.

Objective: To compare the effect of gutter splint and capener splint on hand performance including PIP joint ROM, grip strength, and JHFT scores.

Inclusion Criteria

  • Age group between 20–50 years
    • Both sexes
    • PIP flexion contracture < 50°
    • Boutonniere deformity in RA
    • Post-burns PIP flexion contracture
    • PIP flexion contracture after crush injury, proximal and middle phalanx fractures, tendon injury

Exclusion Criteria

  • Neurological conditions
    • Exacerbation of disease
    • Fixed permanent deformity
    • Differences in PROM less than 10°
    • Dupuytren’s contracture, Trigger finger
    • Wounds on the finger

Procedure

A sample of 20 subjects with PIP flexion contracture participated in the study and were randomly selected for control and experimental groups. Out of 20, 10 were included in control and 10 in experimental group. Hand function performance including PIP joint ROM, grip strength, and JHFT scores were evaluated at pre and post-splint intervention over 12 weeks.

Instruments Used

  • Finger goniometer
    • Jamar Dynamometer
    • Jebsen Hand Function Test

Intervention Protocol

Control group: Gutter splint
Experimental group: Capener splint

Each patient was instructed to wear the splint for at least 6 hours/day for 12 weeks. Exercise protocol and home program were provided. Patients attended follow-up sessions twice a week. Gutter splint was remolded as patient improved.

Data Analysis and Results

Statistical analysis involved mean, SD, t-value, and p-value. Results showed that passive flexion & extension, active flexion, and grip strength were significantly greater in experimental group than control group. Active extension and JHFT scores equally improved in both groups [5-11].

Discussion & Conclusion

Discussion

Among 20 subjects (18 males, 2 females), all were right-hand dominant with PIP flexion contracture mainly due to crush injury and proximal phalanx fractures. Both splints improved active extension significantly (p < 0.001). Capener splint produced better corrective force and improved active and passive flexion compared to gutter splint. Grip strength improvement was greater in the experimental group, likely due to active resistive flexion allowed by capener splint. JHFT scores significantly improved in both groups with no reported discomfort from splints.

Conclusion

Capener splint is more effective than gutter splint for correction of PIP joint flexion contracture.

Limitations of Study

  • Small sample size
    • Limited time period

Recommendations

Further study with larger sample size over longer duration and specific conditions is recommended.

REFERENCES

  1. Prosser R (1996) Splinting in the management of proximal interphalangeal joint flexion contracture. J Hand Ther 9: 378–386.
  2. Strickland JW (1987) Biologic basis for Hand Splinting. In: Fess & Philips, Hand Splinting: Principles and Methods, 2nd Ed. St. Louis, CV Mosby.
  3. Li C (1999) Force analysis of the belly gutter and capener splint. J Hand Ther 12(4): 337–343.
  4. Cecilia (2002) The effect of corrective splinting on PIP joint flexion contracture of rheumatoid fingers. J Hand Ther pp. 185–191.
  5. Jebsen R (1969) An objective and standardized test of hand function. Arch Phys Med Rehab, 50: 311–319.
  6. Schmidt RT, Toews JV (1970) Grip Strength as measured by the Jamar dynamometer. Arch Phys Med Rehabil, June pp. 321–322.
  7. Gwen WZ (2004) Effect of pressure garment work gloves on hand function in patients with hand burns. J Hand Ther pp. 368–376.
  8. Peter JC, Robert LW (2002) Management of Joint Injuries and Intraarticular fractures. In: Hunter-Mackin-Collahan, Rehabilitation of the Hand and Upper Extremity. Vol I, 5th Ed.
  9. Cynthia Cooper (2002) Hand Impairments. In: Trombly CA et al. Occupational Therapy for Physical Dysfunction, 5th Ed.
  10. Tubiana R (1984) Architecture and Functions of the Hand. WB Saunders Co.
  11. Krotoski JAB (2002) Plaster cylinder casting for contractures of the interphalangeal joints.

JCMCRI
ISSN: 3064-8025

Journal of Clinical & Medical Case Reports, Images (JCMCRI) ISSN: 3064-8025 is a peer-reviewed journal dedicated to publishing clinical images from all sectors of medicine. The goal of this magazine is to disseminate information about new discoveries and treatments in science and medicine.

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