title: A prospective randomized controlled trial of dynamic versus static progressive elbow splinting for posttraumatic elbow stiffness.
abstract: BACKGROUND
  Both dynamic and static progressive (turnbuckle) splints are used to help stretch a contracted elbow capsule to regain motion after elbow trauma. There are advocates of each method, but no comparative data. This prospective randomized controlled trial tested the null hypothesis that there is no difference in improvement of motion and Disabilities of the Arm, Shoulder and Hand (DASH) scores between static progressive and dynamic splinting.
  
  
  METHODS
  Sixty-six patients with posttraumatic elbow stiffness were enrolled in a prospective randomized trial: thirty-five in the static progressive and thirty-one in the dynamic cohort. Elbow function was measured at enrollment and at three, six, and twelve months later. Patients completed the DASH questionnaire at enrollment and at the six and twelve-month evaluation. Three patients asked to be switched to static progressive splinting. The analysis was done according to intention-to-treat principles and with use of mean imputation for missing data.
  
  
  RESULTS
  There were no significant differences in flexion arc at any time point. Improvement in the arc of flexion (dynamic versus static) averaged 29° versus 28° at three months (p = 0.87), 40° versus 39° at six months (p = 0.72), and 47° versus 49° at twelve months after splinting was initiated (p = 0.71). The average DASH score (dynamic versus static) was 50 versus 45 points at enrollment (p = 0.52), 32 versus 25 points at six months (p < 0.05), and 28 versus 26 points at twelve months after enrollment (p = 0.61).
  
  
  CONCLUSIONS
  Posttraumatic elbow stiffness can improve with exercises and dynamic or static splinting over a period of six to twelve months, and patience is warranted. There were no significant differences in improvement in motion between static progressive and dynamic splinting protocols, and the choice of splinting method can be determined by the patients and their physicians.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Anneluuk L C
authors.initials: AL
authors.lastname: Lindenhovius
authors.forename: Job N
authors.initials: JN
authors.lastname: Doornberg
authors.forename: Kim M
authors.initials: KM
authors.lastname: Brouwer
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
authors.forename: Chaitanya S
authors.initials: CS
authors.lastname: Mudgal
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D001134:Arm Injuries / Q000150:complications*; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004185:Disability Evaluation; D004551:Elbow Joint / Q000503:physiopathology*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013165:Splints; D000092464:Elbow Injuries