<div dir="ltr">Я обычно кладу перфорированный термопласт в положении гиперкоррекции ногтевой фаланги циркулярно. Когда палец худеет и ортез соскальзывает сам, вопрос уже решен. :) Термопласт можно использовать повторно. С ним можно мыть руки, плавать, мыть помуду и пр.<div><br></div><div>ААЛ</div></div><div class="gmail_extra"><br><div class="gmail_quote">2016-07-19 10:31 GMT+03:00 SAGo <span dir="ltr"><<a href="mailto:orthoforum@weborto.net" target="_blank">orthoforum@weborto.net</a>></span>:<br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">Я очень не люблю "железобетонные" стандарты в медицине. Но какой-то<br>
логично обоснованной линии надо все-таки придерживаться. Поэтому, например.<br>
<br>
UpToDate<br>
Extensor tendon injury of the distal interphalangeal joint (mallet finger)<br>
Author: Rebecca Bassett, MD<br>
Literature review current through: Jan 2016. | This topic last updated:<br>
Sep 11, 2015.<br>
<br>
Acute mallet finger— The goal of mallet finger treatment is to maximize<br>
the function of the distal interphalangeal (DIP) joint while minimizing<br>
discomfort. The majority of mallet fingers are amenable to treatment<br>
with immobilization (ie, splinting), but some complex injuries warrant<br>
surgical referral. (See 'Indications for referral' above.)<br>
The general consensus among experts is that uncomplicated mallet finger<br>
injuries without DIP joint subluxation are best treated with splinting.<br>
The central slip of the proximal interphalangeal (PIP) joint prevents<br>
excessive retraction of the damaged tendon, allowing close approximation<br>
and healing of the torn tendon sections to occur with splinting [12].<br>
Most experts immobilize the DIP joint in full extension or slight<br>
hyperextension (5 to 15 degrees), while allowing full range of motion of<br>
the PIP joint. Clinical experience and the results of one cadaveric<br>
study that assessed the biomechanics of mallet finger injuries support<br>
this approach [13,14]. Primary care and emergency clinicians should not<br>
attempt to reduce any displaced fractures before splinting because any<br>
reduction is unlikely to be maintained without surgery; mallet fingers<br>
with associated fractures are referred.<br>
An aluminum splint can be applied to either the palmar or dorsal surface<br>
of the middle and distal phalanx (picture 3). If possible, the splint<br>
should be bent slightly to stabilize the DIP joint in 5 to 10 degrees of<br>
hyperextension. Hyperextension may be limited initially by swelling or<br>
skin tightness. A stack splint may be used provided the splint is<br>
sufficiently tight to prevent any DIP flexion (picture 4). Custom-made<br>
perforated splints similar to stack splints can be made for fingers that<br>
are difficult to fit and they provide better aeration. An Abouna splint<br>
or metal ring splints are generally not used because of patient discomfort.<br>
Care should be taken to avoid direct, sustained pressure from the splint<br>
on the area of the DIP joint. Excessive pressure or hyperextension can<br>
cause skin necrosis. The Kleinert modified dorsal splint attempts to<br>
avoid this complication by removing the middle third of the foam padding<br>
from the splint, thereby eliminating all direct pressure at the injury<br>
site (picture 5 and picture 6) [14].<br>
In some instances, a swan neck deformity (indicating involvement of the<br>
central slip) accompanies a mallet finger injury. In such cases, both<br>
the DIP and the PIP joints should be immobilized in full extension [14].<br>
Most cases heal well with splinting [10]. A swan neck deformity appears<br>
as a hyperextended PIP joint and a flexed DIP joint (figure 3).<br>
A systematic review identified only four randomized or quasi-randomized<br>
placebo-controlled trials, involving a total of 278 patients that<br>
compared treatments for mallet finger [6]. One trial included in the<br>
review found no difference in outcomes or complications between<br>
fractures treated with splinting versus surgery using wire fixation.<br>
Two systematic reviews found insufficient evidence to determine the best<br>
method for splinting a mallet finger, and the results of two subsequent<br>
randomized trials are consistent with this conclusion [6,15]. One review<br>
found fewer skin complications with custom orthosis versus prefabricated<br>
orthosis, but no differences in treatment success, failure, or extensor<br>
lag [15]. In a randomized trial involving 116 mallet fingers, patients<br>
with custom-made splints had fewer treatment failures compared to those<br>
with stack splints [16]. Improved outcomes in patients treated with<br>
custom splints were noted in one other randomized trial of 64 patients [17].<br>
However, several trials have found that splint type does not affect<br>
outcome. A randomized trial involving 60 patients reported that aluminum<br>
splints fit better and caused fewer skin-related complications than<br>
stack splints, but both splints were equally effective for enabling<br>
tendon healing [18]. Another randomized trial of 77 patients reported no<br>
significant difference in extensor lag or complications based upon the<br>
type of splint selected [19]. We suggest selecting a splint based upon<br>
patient comfort in order to maximize compliance, provided the splint is<br>
sturdy and ensures adequate immobilization and proper positioning.<br>
Follow-up— DIP joint extension splinting is performed for six to eight<br>
weeks. The DIP joint MUST be maintained in full extension throughout the<br>
entire period, including during sleep. Adherence to this instruction is<br>
essential. The most common reason for treatment failure is<br>
noncompliance. Whenever the splint is removed (eg, to clean the finger<br>
or change the splint), the patient must support the distal fingertip in<br>
full extension at all times. Should DIP joint extension be lost at any<br>
point during the initial treatment period, the treatment clock is reset<br>
and an additional six weeks of splinting must be performed. The patient<br>
should be seen every one to two weeks to check on compliance and<br>
complications.<br>
After six to eight weeks of continuous extension splinting with the DIP<br>
joint maintained in full extension, the joint is reexamined and active<br>
extension assessed. If the patient is able to achieve full extension, an<br>
additional two to four weeks of nighttime splinting is performed.<br>
Splinting should be maintained for ALL athletic events for another six<br>
weeks. If necessary, the foam padding of the aluminum splint may be<br>
removed and the aluminum secured directly to the dorsum of the finger to<br>
allow the returning athlete to fit the finger into a glove [12]. Active<br>
range-of-motion exercises are encouraged in these patients to minimize<br>
DIP stiffness.<br>
If a significant extension lag (ie, volar angulation) persists following<br>
the initial six weeks of splinting, the splint is reapplied for up to<br>
six additional weeks [12]. As with the initial treatment period, the DIP<br>
joint MUST be strictly maintained in full extension throughout the<br>
second treatment period. The joint should be reexamined every two weeks<br>
during this second treatment period. Once an acceptable outcome is<br>
achieved, a night splint is used for two to four additional weeks.<br>
<span class="HOEnZb"><font color="#888888"><br>
SAGo<br>
</font></span><div class="HOEnZb"><div class="h5"><br>
<br>
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