No difference between two types of exercise after proximal phalangeal fracture fixation : a randomised trial

Question: 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? Design: Randomised, parallel-group trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. Participants: Sixty-six participants within 1 week of open reduction and internal fixation of proximal phalangeal fractures. Intervention: 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. Outcome measures: 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 –2 kg, 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.