title: No difference between two types of exercise after proximal phalangeal fracture fixation: a randomised trial.
abstract: OBJECTIVE
  Are 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained in an orthosis (constrained exercises) more effective than traditional finger exercises with the metacarpophalangeal joint unconstrained (unconstrained exercises) after open reduction and internal fixation of a proximal phalangeal fracture in terms of impairment, activity limitation and participation restriction at 6 and 12 weeks?
  
  
  METHODS
  Randomised, parallel-group trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors.
  
  
  METHODS
  Sixty-six participants within 1 week of open reduction and internal fixation of proximal phalangeal fractures.
  
  
  METHODS
  The experimental group carried out 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained, whilst the control group carried out finger exercises with the metacarpophalangeal joint unconstrained, as part of a comprehensive rehabilitation program.
  
  
  METHODS
  The primary outcomes were: active proximal interphalangeal joint extension of the injured finger, total active range of motion, and strength. Secondary outcomes were: pain, difficulty with specific hand activity and difficulty with usual hand activity. A blinded assessor measured outcomes at Weeks 1, 6 and 12.
  
  
  RESULTS
  By Week 6, there were no significant between-group differences in improvement for: active proximal interphalangeal joint extension (MD 2 deg, 95% CI -3 to 7); total active finger range of motion (MD 0 deg, 95% CI -21 to 22); strength (MD -2kg, 95% CI -8 to 4); pain (MD 1/50, 95% CI -3 to 5); difficulty with specific hand activity (MD 2/60, 95% CI -3 to 8); or difficulty with usual hand activity (MD 0/40, 95% CI -4 to 3). By Week 12, there were also no significant between-group differences in any outcome.
  
  
  CONCLUSIONS
  Constrained and unconstrained exercises has similar effects after open reduction and internal fixation of proximal phalangeal fracture.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ACTRN12610000294055).
authors.affiliation: Hand Therapy Unit Head, Sydney Hospital.
authors.forename: Lauren
authors.initials: L
authors.lastname: Miller
authors.affiliation: School of Physiotherapy, Western Sydney University.
authors.forename: Jack
authors.initials: J
authors.lastname: Crosbie
authors.affiliation: The University of Sydney.
authors.forename: Anne
authors.initials: A
authors.lastname: Wajon
authors.affiliation: School of Physiotherapy, The University of Sydney, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Ada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005383:Finger Injuries / Q000534:rehabilitation* / Q000601:surgery; D050278:Finger Phalanges / Q000293:injuries* / Q000601:surgery; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult
keywords: Articular range of motion; Finger phalanges; Hand strength; Internal fracture fixation; Physical therapy