| Phair IC et al, 1989, UK | 74 consecutive patients who had sustained a volar avulsion fracture at the PIP joints (size not greater than 2×2 mm) and attended for review between 6 and 24 months after injury. Patients with radiological subluxation were excluded | Retrospective comparative study | Time to regain normal range of movement (weeks) | Mean 5.7 in neighbour strapping group (range 1–16); mean 8.9 in splintage group (range 2–24) | Retrospective |
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| 42 were treated by immobilisation in 30° flexion with an aluminium splint for 1–7 weeks (average 3.1 weeks) and 32 were permitted to mobilise by neighbour strapping for 1–6 weeks (average 2.8 weeks) | | Time to regain normal use (weeks) | Mean 6.8 in neighbour strapping group (range 2–24); mean 10.9 in splintage group (range 3–52) | Not planned interventions; patients seemingly assigned to different treatment groups at the initial treating surgeon’s discretion, no randomisation |
| | | Functional outcome (excellent, good, or poor) | 31 (96.6%) “excellent”’ in neighbour strapping group v 39 (93%) in splintage group | No statistical analysis6patients included following reduction of dorsal dislocation and may have had unstable jointsMobilisation only permitted within the restraints of neighbour strappingAssessments of functional outcome were subjective Functional outcome was assessed by the authors, which may have introduced biasNo standardisation of interventions (large range in duration of strapping or immobilisation)No standardisation of review period (large range in time of review) |
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| Gaine WJ et al, 1998, UK | 192 consecutive patients seen in the hand clinic with volar plate avulsion fractures. Joint dislocations and unstable joints were excluded. 162 patients (with 166 fractures) were followed up for at least 1 year and were included in the analysis | Prospective interventional trial | Functional outcome (excellent, good, poor, or fair, assessed by an independent examiner) | 142 patients (88%) reported excellent outcome (full range of pain free movements); 17 patients (10%) reported good outcome (average 10 degrees PIP joint deformity), 3 patients fair result (intermittent pain and swelling) | Not a controlled trialDiscrepancy with numbers: 162 patients with 166 fractures, but only 3 patients had 2 fracturesSome patients also received ultrasound therapy but this was not standardisedOnly small fractures analysed but no mention of large fractures being excluded or acceptable objective size of fracture for inclusionPatients recruited having been referred to the hand clinic, which may have introduced biasPatients may have been treated with splintage for variable periods before inclusion in the study (two thirds of patients were seen within 1 week and a further fifth within 2 weeks) |