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Plaster or functional splint in gamekeepers thumb
  1. Steve Jones, Specialist Registrar,
  2. Ian Crawford, Clinical Research Fellow

    Abstract

    A short cut review was carried out to establish whether a plaster of Paris or functional splint was better for treatment of ulnar collateral ligament rupture. Altogether 50 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. A clinical bottom line is stated.

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    Report by Steve Jones,Specialist RegistrarSearch checked by Ian Crawford, Clinical Research Fellow

    Clinical scenario

    A young poacher comes into the emergency department complaining of a sore thumb after a night pillaging the local squire's estate. He smells strongly of game birds and clinically he has a rupture of the ulnar collateral ligament of his thumb. You wonder whether to plaster him or place him in a functional splint in the first instance?

    Three part question

    In a [rupture of the ulnar collateral ligament of the thumb] is [plaster immobilisation better than functional splintage of spica] at [reducing instability, arthrosis and pain]?

    Search strategy

    Medline 1966–04/02 using the OVID interface. [{(exp Collateral ligaments OR exp ligaments OR exp ligaments, articular OR ligament$.af) AND (exp Thumb OR thumb.af)} OR (gamekeeper$.af OR skier$.af)] AND [exp Immobilization OR exp Casts, surgical OR exp Splints OR plaster.af OR splint.af OR spica.af] LIMIT to human AND English.

    Search outcome

    Altogether 50 papers were found of which only one was of sufficient quality for inclusion (see table 3).

    Table 3

    Comment(s)

    In this single study immobilisation of the thumb with a moveable splint was strongly preferred by the patients and the functional results of this technique were equal to plaster cast immobilisation after both surgical and non-surgical treatment.

    CLINICAL BOTTOM LINE

    Functional splintage should be used in this group of patients rather than plaster casts.

    Report by Steve Jones,Specialist RegistrarSearch checked by Ian Crawford, Clinical Research Fellow

    References

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