Small splints versus plate fixation for distal radius fractures: A meta- analysis and systematical analysis

Objective:Evaluate the efficacy,safety and economy of small splints and plate in the treatment of distal radius fractures(DRFs).Methods:Seven electronic databases,including PubMed,EMBASE,Cochrane Library,sinomed,CNKI,VIP and Wanfang,were searched for the original study.Literature was screened according to the inclusion and exclusion criteria,and the methodological quality of the included studies was evaluated by Cochrane risk bias assessment tool.The software Revman 5.4 was used for data analysis.Results:A total of 19 studies were included in the study.The clinical effective rate of the plate group[RR=0.96,95%CI(0.93,0.99),P=0.007],Radial inclination[MD=-1.85,95%CI(-2.93,-0.77),P=0.0008],Ulnar inclination[MD=-2.49,95%CI(-3.95,-1.04),P=0.0007],relative height of radius[MD=-1.63,95%CI(-2.40,-0.86),P<0.0001]were better than those in small splints group.There was no significant difference in fracture healing time[MD=-4.39,95%CI(-9.07,0.28),P=0.07]and complications[RR=1.57,95%CI(0.98,2.52),P=0.06]between the two groups.In terms of treatment cost[MD=-2.83,95%CI(-3.37,-2.30),P<0.00001],the small splint group was better than the plate treatment group.Conclusion:Compared with small splints therapy,plate internal fixation has advantages in clinical effective rate and imaging scores.There is no significant difference in fracture healing time and complications between the two groups.In terms of treatment cost,small splint therapy is better than plate therapy.Clinical treatment should be selected and formulated according to the individual situation,demands and clinical practice of patients.

Manual reduction with traditional small splints for distal radius fracture in older patients

Objective:To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods:Older patients(aged at least 60 years)with distal radius fractures were enrolled in this study.The patients were randomly divided into the treatment group and the control group.The treatment group was treated with manual reduction and small splints fixation.The control group was treated with manual reduction and resin plaster fixation.Before treatment,after reduction,and 3 months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length were recorded.Before treatment and 3 months after treatment,the Cooney wrist joint scores were recorded.The time of fracture healing and related adverse events during the treatment were recorded.Results:Before treatment and after reduction,there were no statistically significant differences between the two groups in palmar tilt angle,ulnar deviation angle,or radial length(P>0.05).Three months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length of the treatment group were better than those of the control group(P<0.05).The Cooney wrist scores of the treatment group was significantly higher than that of the control group three months after the treatment(P<0.05).The time of fracture healing of the treatment group was shorter than that of the control group,but the difference was no statistically significant(P>0.05).Conclusions:Compared with resin plaster fixation,traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery.Besides,the method is simple and low cost thus,it needs to be promoted.

Difference in cortical activation during use of volar and dorsal hand splints:a functional magnetic resonance imaging study

There have been no studies reported on the difference in cortical activation during use of volar and dorsal hand splints.We attempted to investigate the difference in cortical activation in the somatosensory cortical area during use of volar and dorsal hand splints by functional magnetic resonance imaging（f MRI）.We recruited eight healthy volunteers.f MRI was performed while subjects who were fitted with volar or dorsal hand splints performed grasp-release movements.Regions of interest were placed on the primary motor cortex（M1）,primary somatosensory cortex（S1）,posterior parietal cortex（PPC）,and secondary somatosensory cortex（S2）.Results of group analysis of f MRI data showed that the total numbers of activated voxels in all ROIs were significantly higher during use of volar hand splint（3,376） compared with that（1,416） during use of dorsal hand splint.In each ROI,use of volar hand splint induced greater activation in all ROIs（M1：1,748,S1 ：1,455,PPC：23,and S2：150） compared with use of dorsal hand splint（M1：783,S1：625,PPC：0,and S2：8）.The peak activated value was also higher during use of volar hand splint（t-value：17.29） compared with that during use of dorsal hand splint（t-value：13.11）.Taken together,use of volar hand splint induced greater cortical activation relevant to somatosensory function than use of dorsal hand splint.This result would be important for the physiatrist and therapist to apply appropriate somatosensory input in patients with brain injury.

Effect of Articular Cavity Injection Combined with Bite Splint Treatment on Anterior Disc Displacement Without Reduction

Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this study were 30 patients with ADDWoR treated in the temporomandibular joint specialist outpatient clinic from November 2018 to November 2019,with a disease duration of 1 to 6 months.The treatment group was treated with an articular cavity injection of sodium hyaluronate+bite splint.The control group was treated with a simple articular cavity injection of sodium hyaluronate.The two groups were followed up once every 2 weeks to evaluate the treatment effect and observe the clinical efficacy of the two groups.Statistical analysis was carried out using SPSS 24.0.t-test and general linear regression analysis were carried out to compare the data of both groups,andχ^(2)-test and binary logistic regression analysis were performed for pain index comparison.Results:There was no significant difference in terms of the efficacy of the treatment received by both groups.The mouth opening and joint pain of patients in both groups were significantly improved after treatment(P<0.001).Conclusion:Articular cavity injection of sodium hyaluronate and occlusal splint therapy are both effective and safe methods for treating ADDWoR.

Effect of occlusal splints for the management of patients with myofascial pain： a randomized, controlled, double-blind study

Background Occlusal splints have been the preferred modalities in the management of myofascial temporomandibular disorders （TMDs）,but now controversy exists in reporting whether they are successful for TMDs treatments.The aim of this study was to give objective evidence to the assessment of treatment effect of occlusal splints for myofascial TMDs patients by clinical assessments and surface electromyography （sEMG） measurements of masseter muscles （MM）.Methods Thirty-six patients （12 males and 24 females） aged 16-57 （38±11） years participated in the study.All participants diagnosed with myofascial TMD were randomized into two groups （18 of each）.Patients in the first group （A） were treated with occlusal splints for 1 month,while patients in the second group （B） were treated with placebo （non-occluding palatal） splints.Clinical assessments were performed at the beginning of the study and 1 month after treatment.sEMG measurements for MM were performed at mandibular postural position （MPP） and maximum intercuspal contacted position （ICP） 1 month after the treatment.The root mean square （RMS） and the median frequency （MF） as linear indices of sEMG data were used to demonstrate muscle activity and muscle fatigue.Data were analyzed by ANOVA and post hoc SNK test.The differences were considered significant at P 〈0.05.Results It was found that 89% of group A either completely recovered （39%） or clinically improved （50%）,while only 22% of group B had a spontaneous improvement.sEMG analysis showed that at MPP,the mean of RMS value of MM in group A was lower than that of group B,which shows statistical differences （P 〈0.01）.At ICP,the RMS value of MM in group A was higher than that of group B,which shows statistical differences （P 〈0.01）.At MPP,MF value of MM in group A was higher than that of group B （P 〈0.05）.At ICP,MF value of MM was lower than that of group B （P 〈0.01）.Conclusions Occlusal splint could eliminate or improve the signs and symptoms of TMD patients with myofascial pain.sEMG analysis indicates that the wearing of occlusal splints may reduce the degree of fatigue of the masticatory muscles.The splint therapy outcome has a correlation with the electromyographic changes in the masticatory muscles.

3D printing of patient-specific neck splints for the treatment of post-burn neck contractures

Dear Editor,Burn scar contracture is a common problem in healing burn wounds of the neck. It can cause both pain and dysfunction if not treated adequately (1)The treatment of such wounds often involves a combination of surgery and splinting therapy (2)A variety of splints, including the thermoplastic static neck splint [3], the Watusi collar [4], manually fabricated splints, and pre-fabricated splints such as the Philadelphia collar have been used for the management of scar contractures. However, each type of splint has its own advantages and disadvantages, and none of these splints seem to reduce the need for skin reconstruction nor delays the time until surgical re-construction [5].

Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.

Applications of finite element simulation in orthopedic and trauma surgery

Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography(CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element(FE) simulation lets us know the biomechanical changes that take place after hipprostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied to the correction of deformities, providing the recovering force-displacement and angle-moment curves that characterize the mechanical behavior of the splint in the overall range of movement.

Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.

基于静态检测的缓冲区溢出漏洞研究

缓冲区溢出漏洞是一种危害严重且常见的软件安全漏洞。静态分析方法不需要执行源代码,便可以提取软件的静态信息,从而检测出软件中安全漏洞。针对静态检测工具Splint在检测缓冲区溢出攻击漏洞方面存在的不足,从检测的功能和可检测的"危险函数"类型两个方面进行了改进。最后使用改进后的Splint工具对几个常用的与网络应用相关的软件包进行检测,检测结果表明改进后的Splint检测工具能够大大地提高检测缓冲区溢出漏洞的效率。

Medial Tibial Stress Syndrome and Female Military Recruits

Upon entering the military recruits are challenged physically, this is exceptionally difficult for women as their anatomy predisposes them to more impact injuries than men. Female military recruits are placed at a higher risk for shin splints, a repetition injury known in the medical field as medial tibial stress syndrome (MTSS). This review paper explores studies about MTSS, its prevalence, and expression in military recruits, particularly as its expression differs across gender. This paper will cover how the external environment of boot camp results in a higher prevalence of MTSS than the general population and how increased occurrence of MTSS in females has been attributed to specific physical attributes. This includes smaller tibial cross-sectional dimensions, greater than average hip range of motion, and differences in lower extremity mechanics during running and other repetitive physical activities. The external environment of boot camp coupled with these intrinsic factors highlight the importance of providing running education for women prior to arrival at boot camp and designing training regiments that account for these physiological differences.

静态检测缓冲区溢出漏洞

缓冲区溢出漏洞是目前惟一最重要最常见的安全威胁。文中分析了防止缓冲区溢出攻击的运行时方法的不足。介绍了一种静态检测缓冲区溢出漏洞的方法及工具。给源代码添加注解,用注解辅助静态分析,用这种方法能够在软件交付使用前,检测出程序中潜在的安全漏洞。

An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders

Anterior repositioning splint(ARS)therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders(TMDs),which account for a large proportion of TMD cases.Owing to the wide application of this therapy,the exact mechanism of remission has increasingly drawn attention.Given that practitioners have different views on ARS therapy,its indications are broadened,and operating methods diverged.This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods.Representative views in the past 10 years were summarised,and conclusions were drawn as follows:The mechanism of ARS therapy is mainly attributed to internal derangement correction,improvement of stress distribution and recently reported joint remodeling.It has an evident effect in the short term,and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months.However,long-term stability is not optimal,and thus indications should be selected carefully.Notably,most of the clinical studies in this field are case analyses with low-quality evidence.Well-designed RCTs are required to further validate relevant theories.

Efficacy of biofeedback therapy via a mini wireless device on sleep bruxism contrasted with occlusal splint:a pilot study

The putative causes of bruxism are multifactorial and there are no definite measures for bruxism management.The aim of this study was to evaluate the efficacy of biofeedback therapy on sleep bruxism,compared with occlusal splint.Twenty-four volunteers with sleep bruxism were divided into two groups：the GTB group that were treated with biofeedback therapy（n 512） and the GTO group that were treated with occlusal splint（n 512）.A mini pressure sensor integrated with a monitoring circuit by use of a maxillary biofeedback splint was fabricated.To foster the relaxation of the masticatory muscles and the nervous system,the wireless device received signals from bruxism events and vibrations alerted the bruxer when the threshold was exceeded.Total episodes and average duration of bruxism events during8 hours of sleep were analyzed with the monitoring program（TRMY1.0）.After 6 and 12 weeks,the episodes（P 50.001） and duration（P,0.05） in the GTB group declined dramatically.In contrast,there were no significant differences in the GTO group after the treatment（P.0.05）.Furthermore,the episodes had significant differences between the GTB group and the GTO group after the same period of treatment（P 5 0.000）.The results suggest that biofeedback therapy may be an effective and convenient measure for mild bruxers,when compared with occlusal splint therapy.The mini wireless biofeedback method may be of value for the diagnosis and management of bruxism in the future.

Treatment of patients with acromioclavicular joint injuries(Rockwood II-VI) with modeled Kirschner wire and cortical screw

Objective: To propose an original method of surgical treatment for the acromial extremity of the clavicle rupture(Rockwood II-VI) with modeled Kirschner wire and cortical screw. Methods: Anatomical study and a test method were applied to 43 cadavers of both sexes. During the period between 2000 and 2013, 34 patients of both sexes were operated upon using the new method. In the comparison group(n = 120), the fixation of the acromial extremity of the clavicle rupture was performed with hamate plate, Lee hook and Kirschner wires.Results: Its application allows, according to the evaluation scale of Constant and Murley(1987), 10% more preservation of the function of the shoulder compared with traditional methods of surgical treatment, and shortens the required hospital treatment and temporary disability periods.Conclusions: It is shown that the proposed author's method combines low invasiveness, minimum dimensions of the construction and low-cost treatment.

Treatment of condylar osteophyte in temporomandibular joint osteoarthritis with muscle balance occlusal splint and long-term follow-up:A case report

BACKGROUND Condylar osteophytes,a remodeling form of temporomandibular joint osteoarthritis(TMJ OA),mainly manifest as marginal angular outgrowths of the condyle.Previous researchers have advocated surgical removal of condylar osteophytes.Reports on the effect of occlusal splint on TMJ OA patients’joints have mostly focused on treatment with this splint,which can reduce the absorption of the affected condyle and promote repair and regeneration.However,the effect of the splint on the dissolution of condylar osteophytes has not yet been reported.CASE SUMMARY A 68-year-old female patient suffered from occlusal discomfort with left facial pain for 2 years.Cone beam computed tomography showed a rare osteophyte on top of her left condyle.She was finally diagnosed with TMJ OA.The patient refused surgical treatment and received conservative treatment with a muscle balance occlusal splint.The pain experienced by the patient on the left side of her face was relieved,and her chewing ability recovered after treatment.The osteophyte dissolved,and the condylar cortex remained stable during long-term follow-up observations.CONCLUSION The muscle balance occlusal splint could be a noninvasive means of treating condylar osteophytes in TMJ OA patients.

A preliminary study on the treatment of bruxism by biofeedback therapy

Objective: To evaluate the effect of wireless biofeedback therapy on bruxism. Methods: Fifteen bruxiers participated to be treated by this therapy. The abnormal movements of teeth during sleep were monitored by a maxillary splint with an electric resistance strain gauge. Meanwhile, the receiver device recorded these details and analyzed the data, including the value of the biting force, occurring time and duration. If the value of biting force or duration exceeds the threshold, a vibrating device like a watch style will alert the patient to relax the masticatory muscles and nervous system to stop the abnormal grinding or clenching. Data were recorded during 8 hours’ sleep and analyzed after the 12 weeks’ treatment and 24 weeks’ treatment. Results: The average episodes of bruxism have declined from (10.60 ± 1.23) to (6.60 ± 0.75) after 12 weeks’ treatment (p < 0.05), and the average duration of bruxism events was reduced from (13.2 ± 0.74) s to (6.50 ± 0.40) s (p < 0.05). The average episodes of bruxism have declined to (3.80 ± 0.64) after 24 weeks’ treatment, and the average duration of bruxism events was reduced to (3.37 ± 0.34) s (p < 0.05). Conclusions: The results suggest that biofeedback therapy can be effective for bruxism treatment.

Agma Splint固定夹板联合中成药对桡骨远端骨折的临床疗效分析

目的:分析Agma Splint固定夹板联合中成药对桡骨远端骨折的治疗效果。方法:选择2011年5月-2012年5月于笔者所在医院就诊的148例桡骨远端骨折患者,随机分为试验组86例和对照组62例,对照组使用小夹板固定治疗,试验组使用Agma Splint固定夹板进行治疗。观察两组患者的治愈情况。结果:试验组治愈83例,治愈率达96.5%,对照组治愈50例,治愈率达80.6%,两组患者治愈率比较差异有统计学意义(字2=9.96,P<0.05)。结论:Agma Splint固定夹板联合中成药对桡骨远端骨折具有有效、简便、治愈率高等优势,适合临床长期推广应用。

Current situation and consideration of small splint in the treatment of distal radius fracture complicated with ulnar styloid process fracture

Objective:The incidence of distal radius fracture combined with ulnar styloid process fracture is increasing,which seriously affects the quality of life of patients.Small splint therapy of Traditional Chinese Medicine is a reliable method for the treatment of such fractures.It not only has good clinical efficacy,but also has fewer complications and high safety.However,the traditional small splint fixation does not cover the styloid process of the ulna,and the fracture of the styloid process of the ulna is closely related to the stability of the wrist joint,which has an important impact on the prognosis of the fracture.Based on this,we believe that the ulnar elongation splint can better improve the wrist function,and further prospects for related issues,in order to guide clinical practice.

Long-term follow-up of a patient with venlafaxine-induced diurnal bruxism treated with an occlusal splint:A case report

BACKGROUND Bruxism is a jaw-muscle activity characterized by the clenching or grinding of teeth. It can be divided into nocturnal bruxism and diurnal bruxism(DB). DB secondary to antidepressants is rare and refractory. Reports associated with antidepressant-induced DB are mostly anecdotal without long-term follow-up.The effect of drug intervention on antidepressant-induced DB is still contested.We herein report the first case of successful treatment of venlafaxine-induced DB with an occlusal splint.CASE SUMMARY This case report describes detailed 7-year follow-up of a patient with venlafaxineinduced DB treated with an occlusal splint. The patient who complained about involuntary daytime tooth grinding after taking venlafaxine for a period of 4 mo and was diagnosed with venlafaxine-induced DB. Subsequently, an occlusal splint with modified bilateral buccal-pterygoid pads was used to treat his tooth grinding and to protect the dental structures from tooth wearing. The patient reported remission of symptoms after several months of treatment. His grinding activity was gradually and stably controlled after 2 years, with an almost complete recovery from DB after 6 years.CONCLUSION The maxillary buccal-pterygoid splint can be used as a noninvasive approach to treat venlafaxine-induced DB.