Thumb fractures - Eurohand2011 - Oslo (Norway)

Thumb fractures : rehabilitation and splinting following intra-articular fracture of the trapezometacarpal joint

S CELERIER (PT), C. CAMPS, A. DURAND, M. ISEL, B. LALLEMAND, M. MERLE

European Hand Institute - Nancy (FRANCE)

Purpose: The thumb is articulated with its base by the trapezometacarpal joint (or carpometacarpal joint CMC). The trapezium (Tz) is a fixed bone, when the first metacarpal is mobile. The CMC joint ensures the stability and the mobility of the first finger. The thumb has an essential part in the hand function for the prehension.   Fractures of the thumb metacarpal occur most frequently at the base with an important functional impact. In 1882, BENNETT describes the fracture-luxation of the base of the first metacarpal (Bennett’s fracture). The 1^st metacarpal moves by the action of the Abductor Pollicis Longus (APL) and the thenar muscles. It’s an intra-articular frequent fracture requiring adequate reduction. A secondary rehabilitation of good quality is undeniable.

Methods: Faithful to the “TTMP” doctrine (treatment of one time with early mobilization / Tout en un Temps avec Mobilization Précoce) describe in 1977 by FOUCHER, MERLE et MICHON, rehabilitation must encourage an early range of motion as soon as possible. The objectives are 1) the control of the edema 2) the prevention of the stiffness 3) and to maintain the tendons glides with the prevention of the tendon’s adherences. Those protocols combine inevitably specific rehabilitation and achievement of splints. Co-operation between patient and therapist is vital.

Results: Custom-made splints are appropriate for the treatment of intra-articular fractures. They respect a better immobilization position, the physiological curve of the patient, and an early range of motion. Rehabilitation must combine immediate self-mobilization and specific treatments by an experienced therapist.

Conclusion: Stiffness and osteoarthritis are the main consequences of these articular traumas, common cause of pain and poor hand function. These injuries are a challenge for a multi-disciplinary team. Economical incidence must be considered.

References :
Bennett EH. Fractures of the metacarpal bone of the thumb. British Medical Journal 1886 ; 2 : 12-13
Baker RP. Does postoperative hand elevation reduce swelling ? A randomized study. Journal of Hand Surgery (European volume) 2010, vol 35, n°3, 192-194
Corcella D. Les fractures récentes de la base du premier métacarpien. Cahier d’enseignement de la SFCM 2001 ; 13 : 35-47
Colditz JC. The biomechanics of the thumb carpometacarpal immobilization splint : Design and Fitting. Journal of Hand Therapy 2000 : 228-231
Merle M, Voche Ph. Fractures des métacarpiens et des phalanges. La main traumatique, 1. L’urgence 2010 : 78-104
Michon J, Foucher G, Merle M. Traumatismes complexes de la main. Traitement tout en un temps avec mobilisation précoce. Chirurgie 1977 ; 103 : 956-964.
Packer JW, Colditz JC. Bone injuries : Treatment and Rehabilitation. Hand clinics 1986 : 81-91
Tubiana R. La mobilisation précoce des fractures des métacarpiens et des phalanges. 
Annales de chirurgie de la main 1983 ; 2 : 293-297

Course (June 2011)

HAND SPLINTS COURSE

Marin Philippe DURAFOURG (Paris) Sylvain CELERIER (Nancy)

Course objectives :

• to make hand splints with thermoplastic materials
• to acquire basic skills to become a proficient splint maker (variety of hand and wrist splints)
• to construct specific splints designs
• to create precise splints patterns
• to acquire a basic understanding of dynamic splints...

12 contact hours (French course)

Dates : 6/17/2011 - 6/18/2011
Location : Paris (France)
Register now !  www.kpten.fr

Presentation (2010)

Evidence-based practice and professional guidelines : statement and prospects of hand rehabilitation

Claude LE LARDIC (Nantes) Sylvain CELERIER (Nancy)

Annual congress GEMMSOR and annual congress GEM
Dec 17, 2010 - Paris (France)

Bibliography :

 J.P. REGNAUX, V. GUAY, C. MARSAL 2009 ; Evidence-based practice ou la pratique basée sur les preuves en rééducation. Kinésithérapie la revue 2009 ; 94 : 55-61.

D.L. SACKETT, W.M. ROSENBERG, J.A. GRAY, R.B. HAYNES, W.S. RICHARDSON 1996 ; Evidence-based medecine : what it is and what it isn’t. BMJ 1996 ; 312 : 71-2.

J. ANDRE-VERT 2009 ; Elaboration des recommandations professionnelles par la Haute Autorité de Santé. Kinésithérapie la revue 2009 ; 85-86 : 42-43.

M. GEDDA 2009 ; Rééducation à domicile ou en institution : méthodologies de consensus. Kinésithérapie scientifique 2009 ; 503 : 5-8.

Haute Autorité de Santé (HAS). Bases méthodologiques pour l’élaboration des recommandations professionnelles par consensus formalisé. Guide méthodologique. Saint-Denis-La-Plaine : HAS, janvier 2006. www.has-sante.fr

Agence Nationale d’accréditation et d’évaluation en santé (ANAES). Les recommandations professionnelles pour la pratique clinique  - Base méthodologique pour leur réalisation en France. Guide méthodologique. Paris : ANAES, avril 1999.

A. MOORE 2009 ; Physiothérapie mondiale, les cinq prochaines années. Kinésithérapie la revue 2009 ; 92-93 : 1.

P. TRUDELLE 2007 ; La kinésithérapie basée sur les preuves à la WCPT et la recherche et développement. Congrès international de la WCPT 2007, Vancouver – Canada. Kinésithérapie la revue 2007 ; 68-69 : 36-39.

P. PORTERO 2008 ; Recherche et kinésithérapie en France. Kinésithérapie scientifique 2008 ; 492 : 33.

T. SCHAEVERBEKE 2008 ; L’évaluation : mode ou nécessité ? Rhumatos 2008 ; 38(5) : 196.

Presentation (2010)

Splinting and rehabilitation following secondary surgery for PIP Fractures

CELERIER Sylvain, Micheline ISEL*
Pr MERLE Michel*, Dr Christophe CAMPS*, Dr Alexandre DURAND, Dr Bernard LALLEMAND*
Nancy (France) Luxembourg*

Congress of the French Society For Hand Therapists
Sept 18, 2010 - Lille (France)

Bibliography :

 F. MOUTET, A. FORLI, D. CORCELLA, Ph. PRADEL 2008. L’IPP : un épicentre ? Arthropathies des MCP et IPP, actualités thérapeutiques Y. ALLIEU, J. L. ROUX, G. MEYER ZU RECKENDORF. Sauramps Médical ; Montpellier. 75-87.

J. MICHON, G. FOUCHER, M. MERLE 1977. Traumatismes complexes de la main. Traitement tout en un temps avec mobilisation précoce. Chirurgie 1977 ; 103 : 956-964.

T. DUBERT 2010. Stiffness and malunions. Conférence symposium « Lésions articulaires traumatiques du membre supérieur chez l’adulte ». Paris mai 2010.

M. MERLE, Ph. VOCHE, B. LALLEMAND, A. DURAND, M. ISEL, S. CELERIER 2010. Fractures des métacarpiens et des phalanges. La main traumatique 1. L’urgence 3^e édition M. MERLE, G. DAUTEL. Masson ; Paris. 78-104.

B. LALLEMAND, A. DURAND, M. MERLE 2008. L’arthroplastie IPP Neuflex© par voie latérale. Arthropathies des MCP et IPP, actualités thérapeutiques Y. ALLIEU, J. L. ROUX, G. MEYER ZU RECKENDORF. Sauramps Médical ; Montpellier. 101-107.

M. MERLE 2008. Pourquoi les prothèses totales contraintes et semi-contraintes IPP et MCP sont voués à l’échec ? Arthropathies des MCP et IPP, actualités thérapeutiques Y. ALLIEU, J. L. ROUX, G. MEYER ZU RECKENDORF. Sauramps Médical ; Montpellier. 175-179.

G. FOUCHER, P. GREANT, S. EHRLER 1989. Le rôle de l’orthèse dans le traitement des raideurs de la main. Chirurgie 1989, 115/2, 100-105.

J. HANNA 2010. PIP joint replacement. Conférence workshop 8th triennial congress of International Federation of Societies for Hand Therapy IFSHT “Entwining the world of hand therapy “, Orlando, 24-26 june 2010. www.asht.org/meeting/handouts/2010_ifsht_handouts.cfm

J. M. ANDRE, C. GABLE, J. XENARD, J. BERNARD, D. PETRY 1994. Atlas pratique des orthèses de la main. Paris : Springer Verlag, 1994. 260p

Presentation (2009)

XLVth Meeting of the French Society for Hand Surgery (GEM SFCM)
and Meeting of the French Society For Hand Therapists (GEMMSOR)

Rheumatoïd arthritis : medical, social and organisational aspects of treatment (excluding surgery and drugs)
Treatment for the hand and the wrist

CELERIER Sylvain (Nancy) ANDRE-VERT Joelle (Saint Denis La Plaine) GUILLEZ Pascal (Berck-Sur-Mer) MAYOUX-BENHAMOU Marie Anne (Paris)

Dec 18, 2009 - Paris (France)

"Dynamic and aerobic physical activities are recommended (grade B). Therapeutic patient education is recommanded (Grade B).
Splints for the hand and the wrist :
The wearing of splints is recommended for analgesic, functional or corrective purposes after clinical assessment for the following inidcations :
- temporary immobilisation of very inflamed joints (during rest periods)
- stabilisation of destroyed joints (during activities)
- correction of deformities that can be reduced.
Customized splints are generaly better adapted than off-the-shelf splints (profesionel agreement).
Rest splints should be prescribed for the flare-ups involving local inflammation of the hands (Grade C).
Functional splints should be prescribed to facilitate the conduct of daily activities (Professional agreement).
Corrective splints should be prescribed to correct deformities that may be reduced (Pofessional agreement).
Specific programs for joint protection :
Every patient with RA should benefit from an educational program on joint protection that is adapted to the disease, patient and environment (Grade B).
Therapeutic exercises for the hands :
every patient whose hands are affected by rheumatism should do regular exercises for the hands (Grade C). The exercises are taught by a health professional and then carried out by the patients on their own (Professional agreement).
Physical agents for the hands :
Physical agents should not be used on their own. They may be used as an adjuvant to physiotherapy or to symptomatic treatment with analgesics after assessment with the patient of the 'excepted benefits versus constraints' ratio (Professional agreement). "

Rheumatoïd arthritis : medical, social and organisational aspects of treatments - Guidlines
Haute Autorité de Santé - Paris (France), March 2007
www.has-sante.fr/portail/jcms/c_533480/

Publication (2009)

Hand splints : fundamentals on supportive braces for the hand, wrist and fingers
CELERIER Sylvain

Abstract :

Introduction: Hand, wrist and finger ortheses are an important part of the therapeutic armamentarium for hand disorders whether caused by trauma, neurological deficit, rheumatoid disease or a degenerative process. They are a crucial element for hand rehabilitation.

Purpose: The purpose of this article is to present the fundamental aspects of hand ortheses, as used in daily practice, and demonstrated by a specialized pluridisciplinary team.

Material and methods: After recalling the indispensable prerequisites, we expose our experience of exclusively custom-

made devices.

Results: The process involves the choice of the thermomodulable material and especially expert knowledge of supportive devices and their use. Indications are specific, with variable objectives, from temporary immobilization to recovery of joint range of motion. We propose a classification according to the initial context of the medical prescription.

Conclusion: Custom-made devices adapt better to each individual morphology, irrespective of the deformity, compared with manufactured devices. These custom-made devices must be precise and effective to meet the specific goals of each situation. Monitoring is a fundamental step of the therapeutic process.

Keywords : Template – Hand – Orthesis – Orthopedics – Monitoring –Thermomodulable

Kinésithérapie, La revue (Geste pratique) 2009;(95):21-29
Elsevier Masson SAS. Tous droits réservés

Publication (2008)

Rehabilitation and splinting of the hand ans wrist in rheumatoïd arthritis during the medical and surgical treatment.
CELERIER Sylvain, ISEL Micheline, MERLE Michel

Abstract: Given the complexity of wrist and digital deformities, rehabilitation and re-adaptation, in complement with medical and surgical therapies, play an integral part in the multi-disciplinary approach to the treatment of rheumatoid arthritis. Regardless of the evolutionary stage of disease, the objective is to limit the many consequences of the disease felt in the patient’s daily life, preserving comfort, increasing functional autonomy, and limiting aesthetic embarrassment thus allowing patients to lead a normal life, in both their social and professional spheres.

The importance of rehabilitation varies according to the evolution of the disease, from the beginning inflammatory phases, to the deformation phase, and eventually the medical and surgical stages. The latest innovations in digital arthroplasty increase the chance of early mobilization thus helping to limit the fatigability of these multi-operated patients. Specific bracing and rehabilitation protocols remain indissociable to this strategy.

Keywords: rheumatoid arthritis, physical therapy, splint, hand, wrist, self rehabilitation, digital arthroplasty

EMC (Elsevier Masson SAS, Paris)
Kinésithérapie-Médecine physique-Réadaptation, 26-220-B30,2008
www.em-consulte.com/article/69117