Is Post-Operative Splinting Advantageous after Upper Extremity Fracture Surgery? Results from the Arm Splint Pain Improvement Research Experiment (ASPIRE)

Abstract

OBJECTIVES: To determine if short-term immobilization with a rigid long arm plaster elbow splint following surgery of the arm, elbow, or forearm results in superior outcomes compared to a soft dressing with early motion. METHODS: Design: Prospective Randomized Control Trial Setting: Academic Medical Center Patient Selection Criteria: Patients undergoing operative treatment for a mid-diaphysis or distal humerus, elbow, or forearm fracture were consented and randomized according to the study protocol for post-operative application of a rigid elbow splint (10-14 days in a plaster Sugar Tong Splint for forearm fracture or a Long Arm plaster Splint for 10-14 for all others) or soft dressing and allowing immediate free range of elbow and wrist motion (ROM). Outcome Measures and Comparisons: Self-reported pain (visual analog score or VAS), Health-Scale (0-100, 100 denoting excellent health) and physical function (EuroQol 5 Dimension or EQ-5D) surveyed on post-operative days 1-5 and 14 were compared between groups. Patient reported pain score (0-10, 10 denoting highest satisfaction) at week 6, time to fracture union, ultimate DASH score and elbow range of motion (ROM) were also collected for analysis. Incidence of complications were assessed. RESULTS: 100 patients (38 males to 62 females with a mean age of 55.7 years old) were included. Over the first five days and again at post-op day 14, the splint cohort reported a higher “Health-Scale” from 0-100 than the non-splint group on all study days (p=0.041). There was no difference in reported pain between the two study groups over the same interval (p=0.161 and 0.338 for least and worst pain, respectively) and both groups reported similar rates of treatment satisfaction (p=0.30). Physical function (p=0.67) and rates of wound problems (p= 0.27) were similar. Additionally, the mean time to fracture healing was similar for the splint and control groups (4.6 ± 2.8 vs 4.0 ± 2.2 months, p=0.34). Ultimate elbow range of motion was similar between the study groups (p=0.48, p=0.49, p=0.61, p=0.51 for elbow extension, flexion, pronation, and supination respectively. CONCLUSIONS: Free range of elbow motion without splinting produced similar results compared to elbow immobilization following surgical intervention for a fracture to the humerus, elbow, and forearm. There was no difference in patient-reported pain outcomes, wound problems, or elbow ROM. Immobilized patients reported slightly higher “health scale” ratings than non-splinted patients, however similar rates of satisfaction. Both treatment strategies are acceptable following upper extremity fracture surgery.