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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Shorter versus longer immobilization after surgery for thumb carpometacarpal osteoarthritis: a propensity score matched study

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  • presenting/speaker Jonathan Tsehaie - Erasmus MC, Rotterdam, Netherlands
  • Robbert M. Wouters - Erasmus MC, Xpert Clinic, Rotterdam, Netherlands
  • S. E. R. Hovius - Erasmus MC, Xpert Clinic, Rotterdam, Netherlands
  • Reinier Feitz - Xpert Clinic, Rotterdam, Netherlands
  • Harm P. Slijper - Erasmus MC, Xpert Clinic, Rotterdam, Netherlands
  • Ruud W. Selles - Erasmus MC, Xpert Clinic, Rotterdam, Netherlands

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-543

doi: 10.3205/19ifssh0948, urn:nbn:de:0183-19ifssh09480

Published: February 6, 2020

© 2020 Tsehaie et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: To investigate if shorter immobilization is non-inferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritis

Methods: Participants that received short immobilization (3-5 days plaster cast followed by a thermoplastic thumb spica splint until 4 weeks) were compared with prolonged immobilization (10-14 days plaster cast followed by a thermoplastic thumb spica splint including until 6 weeks). All the participants were surgically treated with the Weilby procedure and matched using propensity score matching (PSM) to control for confounders. Primary outcomes were pain measured with a Visual Analogue Scale (VAS) and hand function measured with Michigan Hand Questionnaire (MHQ) at six weeks, three months and twelve monhts. Secondary outcomes were complications, range of motion, grip and pinch strength, satisfaction with treatment and return to work.

Results and Conclusions: We matched 131 participants with shorter immobilization and 131 participants with longer immobilization. No significant differences were found in VAS pain (effect size 0.03, 95% C.I. -0.21-0.27) or the MHQ (effect size 0.01, 95% C.I. -0.23-0.25) between the groups at three months or at twelve months. Furthermore, no differences were found in complication rate or in other secondary outcomes.

In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal compared to longer immobilization for outcomes on pain, hand function and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following CMC-1 arthroplasty.