Pre-Operative Serial Casting for Dupuytren's Contracture Involving the PIP Joint
October 2008 No. 2
Pre-Operative Serial Casting for Dupuytren's Contracture Involving the PIP Joint
by Judy Colditz, OT/L, CHT, FAOTA
It is well know that the outcome following Dupuytren’s fasciectomy is often poor when surgical release of a severe PIP joint flexion contracture must also occur. Pre-operative serial casting of the PIP joint prior to fasciectomy, however, can make the surgical excision of the Dupuytren’s easier and improve the final outcome. (Dupuytren’s contracture will respond to serial casting/splinting, but one cannot expect permanent change; when the casting/splinting is discontinued the contracture recurs.) Surgeons I have worked with describe easier excision of the fascial bands because of diminished convolution, having enough skin length to avoid the need for a skin graft, and a reprieve from performing a capsulotomy.
If there is disruption of the tendon due to a mallet injury, tension potentially causes a “gap” to form between the healing tendon ends.
Dupuytren’s: Combined MP and PIP joint flexion contractures are ideal for pre-operative serial casting.
You may want to discuss the possibility of preoperative serial casting with your referring surgeon for those patients with Dupuytren’s contracture who have PIP joint flexion contractures. Your surgeon will appreciate the fact that pre-operative therapy can make the surgery technically easier!!!
First step is a volar plaster slab across all joints, reinforced with either a small piece of thermoplastic material or a small longitudinal roll of plaster of Paris.
Final step is wrapping plaster of Paris around the entire finger to hold the volar slab in place so both joints are held at easy maximum extension.
Additional Suggested Reading
Clinical Pearl No. 30 - Should all Orthoses be 2/3 the Length of the Forearm?
Clinical Pearl No. 14 – How Long Should I Serial Cast a Finger?
Clinical Pearl No. 13 – Why I Dislike Ulnar/Radial Gutter Splints!!
Clinical Pearl No. 12 – Why I Avoid Passive Flexion of the DIP Joint
Clinical Pearl No. 7 – Attaching Interface Mold to Splint Surface
Clinical Pearl No. 5 – “Splint” Suggestion for the Hypermobile Wrist
Clinical Pearl No. 4 – Leather, The Forgotten Strapping Material
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Disclaimer: BraceLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.