بریکٹ، سپلنٹ اور سپورٹس

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• Sling immobilization is not inferior to brace immobilization after arthroscopic rotator cuff repair [1].
• The conclusion that sling immobilization is not inferior to brace immobilization cannot be attributed solely to the type of immobilization [1].
• Removable splints can be used safely for minimally displaced distal radial fractures [2].
• Treatment with removable splints for minimally displaced distal radial fractures saves patients time and inconvenience regarding additional hospital visits [2].
• Treatment with removable splints for minimally displaced distal radial fractures saves the healthcare system money [2].
• The Cross Brace Protocol provides an additional non-operative option for ACL injuries [3].
• The Cross Brace Protocol may be associated with satisfactory anatomical and functional healing for certain patient groups with ACL injuries [3].
• Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement in the management of trigger finger [4].
• Findings regarding proximal interphalangeal joint orthosis and therapeutic exercise for trigger finger cannot establish superiority over other conservative treatments due to the absence of a control group [4].
• Four weeks of cast immobilization is sufficient for most distal radial fractures in elderly patients [5].
• Splinting is an effective short-term conservative treatment for trigger finger [6].
• Splinting offers symptom relief and functional improvement comparable to corticosteroid injections for trigger finger [6].
• Kinesiotaping can be considered an alternative choice of supplementary treatment together with exercise therapy for shin splints [7].
• Supportive bandage, removable splint, and walking casts are all well tolerated with similar complication rates for low-risk ankle fractures in children [8].
• There remains equipoise regarding the best treatment of low-risk ankle fractures in children among supportive bandage, removable splint, and walking casts [8].
• Orthoses offer a good alternative to plaster casts for the conservative treatment of distal radius fractures, especially for stable fracture types [9].
• Adult patients with a fracture of the waist of the scaphoid displaced by ≤ 2 mm should be treated initially with immobilization in a cast [14].
• Early fixation of a nonunion is recommended following initial cast immobilization for adult patients with a fracture of the waist of the scaphoid displaced by ≤ 2 mm [14].

How It Works¶

• Sling immobilization is not inferior to brace immobilization after arthroscopic rotator cuff repair, though this conclusion cannot be attributed solely to the type of immobilization [1].
• Removable splints for minimally displaced distal radial fractures save patients time and inconvenience regarding additional hospital visits and save the healthcare system money [2].
• The Cross Brace Protocol provides an additional non-operative option for ACL injuries and may be associated with satisfactory anatomical and functional healing for certain patient groups [3].
• Proximal interphalangeal joint orthosis and therapeutic exercise for trigger finger demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments due to the absence of a control group [4].
• Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement comparable to corticosteroid injections [6].
• Supportive bandage, removable splint, and walking casts for low-risk ankle fractures in children are all well tolerated with similar complication rates [8].
• Orthoses offer a good alternative to plaster casts, especially for stable fracture types [9].
• Pain and functional outcomes after primary reverse total shoulder arthroplasty with no immobilization are comparable to those obtained with a 3-week immobilization period [10].
• Union consolidated in patients with scaphoid waist fractures and > 20% bridging without intervention between one and five years after randomization [11].
• Symptom severity, pain, hand function, and orthosis wearability outcomes support interchangeable use of relative motion and metacarpophalangeal joint blocking orthoses for managing trigger finger [12].
• Maintaining an appropriate balance between mobilization and immobilization is a central challenge in hand rehabilitation and has a decisive impact on tissue healing, functional recovery, and patient outcomes [15].
• The application of mid-frequency electrical muscle stimulation during the immobilization period after arthroscopic rotator cuff repair effectively prevented early post-operative deltoid muscle atrophy and accelerated early recovery of shoulder muscle strength [17].

What the Evidence Shows¶

Upper Extremity Fractures and Dislocations¶

• Sling immobilization is not inferior to brace immobilization after arthroscopic rotator cuff repair, though the conclusion cannot be attributed solely to the type of immobilization [1].
• Orthoses offer a good alternative to plaster casts, especially for stable fracture types, in the conservative treatment of distal radius fractures [9].
• Pain and functional outcomes are comparable between no immobilization and a 3-week immobilization period in primary reverse total shoulder arthroplasty [10].
• Union consolidated in patients with greater than 20% bridging without intervention between one and five years after randomization for scaphoid waist fractures [11].
• Adult patients with a fracture of the waist of the scaphoid displaced by 2 mm or less should be treated initially with immobilization in a cast, followed by early fixation of a nonunion [14].
• Waterproof casts provide an alternative to standard casts with improved functional outcomes, comfort, and less itching at the time of cast removal for upper limb fractures in children [13].

Lower Extremity Fractures and Ligament Injuries¶

• Athletes who underwent ulnar collateral ligament repair with an internal brace reported excellent midterm patient-reported outcomes statistically similar to those after ulnar collateral ligament reconstruction, including the proportion successfully returning to preinjury sport [22].
• The embrace technique yielded equivalent outcomes compared with suture button fixation for managing syndesmotic injuries [23].

Hand and Soft Tissue Conditions¶

• Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement for trigger finger, but cannot establish superiority over other conservative treatments due to the absence of a control group [4].

Practical Considerations¶

• The conclusion that sling immobilization is not inferior to brace immobilization after arthroscopic rotator cuff repair cannot be attributed solely to the type of immobilization [1].
• Treating patients with minimally displaced distal radial fractures using a removable splint saves them time and inconvenience regarding additional hospital visits [2].
• Treating patients with minimally displaced distal radial fractures using a removable splint saves the healthcare system money [2].
• Findings from a prospective case series on proximal interphalangeal joint orthosis and therapeutic exercise for trigger finger demonstrate feasibility and short-term clinical improvement [4].
• Findings from a prospective case series on proximal interphalangeal joint orthosis and therapeutic exercise for trigger finger cannot establish superiority over other conservative treatments due to the absence of a control group [4].
• There remains equipoise regarding the best treatment of low-risk ankle fractures in children [8].
• Supportive bandage, removable splint, and walking casts all appear well tolerated with similar complication rates for low-risk ankle fractures in children [8].
• Pain and functional outcomes are comparable to those obtained with a 3-week immobilization period in primary reverse total shoulder arthroplasty [10].
• Waterproof casts provide an alternative to standard casts for upper limb fractures in children [13].
• Waterproof casts provide improved functional outcomes, comfort, and less itching at the time of cast removal compared to standard casts for upper limb fractures in children [13].
• Limitations of 3D-printed orthoses include small sample sizes, lack of standardized assessment methods, and durability concerns [16].
• In the absence of routine access to expert psychosocial/psychological practitioners, trauma clinicians provided psychosocial support using a variety of approaches [18].
• The use of various approaches by trauma clinicians for psychosocial support results in disparities in how psychosocial care is provided to patients in Australia and New Zealand [18].
• Initial cast immobilization with fixation for nonunion is the optimal form of treatment for adults with a scaphoid waist fracture [19].
• The small quality-adjusted life year gains for adults with a scaphoid waist fracture who underwent surgery initially were not sufficient to justify the higher costs compared to initial cast immobilization [19].
• Use of a codesigned patient decision aid in practice was feasible for patients considering total knee arthroplasty [20].

Key Evidence¶

• [L5] They argue that the conclusion that sling immobilization is 'not inferior' to brace immobilization cannot be attributed solely to the type of immobilization. [1] (10.1002/arj.70326)
• [L2] If patients can be treated safely using a removable splint, this will save them time and inconvenience in terms of additional visits to the hospital, and save the healthcare system money. [2] (10.1302/0301-620x.107b1.bjj-2024-0634.r1)
• [L2] The Cross Brace Protocol provides an additional non-operative option for ACL injuries and may be associated with satisfactory anatomical and functional healing for certain patient groups. [3] (10.1177/2325967126s00013)
• [L4] Because of the absence of a control group, these findings demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments. [4] (10.1016/j.jhsg.2026.101038)
• [L5] The authors should be commended for a well-designed, well-executed randomized controlled trial that makes a compelling case that 4 weeks of cast immobilization is sufficient for most distal radial fractures in elderly patients. [5] (10.2106/jbjs.25.00333)
• [L2] Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement comparable to corticosteroid injections. [6] (10.1016/j.jhsg.2025.100881)
• [L5] Shin Splints is a rare antity and when diagnosed; kinesiotaping can be thought as an alternative choice of supplementary treatment together with exercise therapy. [7] (10.1016/s0020-1383(13)70151-7)
• [L2] There remains equipoise regarding the best treatment of these injuries, with all three treatments appearing well tolerated with similar complication rates. [8] (10.1302/0301-620x.107b1.bjj-2024-0354.r1)
• [L1] Hence, orthoses offer a good alternative to plaster casts, especially for stable fracture types. [9] (10.1186/s12891-026-09585-4)
• [L1] The pain and functional outcomes are comparable to those obtained with a 3-week immobilization period. [10] (10.1016/j.jse.2025.02.015)
• [L1] Between one and five years after randomization, union consolidated in those with > 20% bridging without intervention. [11] (10.1302/0301-620x.108b1.bjj-2025-0125.r1)
• [L1] Symptom severity, pain, hand function, and orthosis wearability outcomes support interchangeable use of relative motion and metacarpophalangeal joint blocking orthoses for managing trigger finger. [12] (10.1016/j.jht.2025.05.018)
• [L1] Waterproof casts provide an alternative to standard casts with improved functional outcomes, comfort, and less itching at the time of cast removal. [13] (10.1302/0301-620x.107b6.bjj-2025-0011)
• [L1] The recommendation that adult patients with a fracture of the waist of the scaphoid which is displaced by ≤ 2 mm should be treated initially with immobilization in a cast, followed by early fixation of a nonunion, is further corroborated by these findings. [14] (10.1302/0301-620x.108b1.bjj-2025-0122.r1)
• [L5] The review highlights that maintaining an appropriate balance between mobilization and immobilization is a central challenge in hand rehabilitation and has a decisive impact on tissue healing, functional recovery and patient outcomes. [15] (10.1177/17531934251413908)
• [L1] However, limitations such as small sample sizes, lack of standardized assessment methods, and durability concerns must be addressed through further research. [16] (10.1186/s12891-025-09070-4)
• [L3] The application of the MFEMS during immobilization period after ARCR effectively prevented early post-operative deltoid muscle atrophy and accelerated early recovery of shoulder muscle strength. [17] (10.1002/ksa.70303)
• [L5] In the absence of routine access to expert psychosocial/psychological practitioners, trauma clinicians provided psychosocial support using a variety of approaches which results in disparities in how psychosocial care is provided to patients in Australia and New Zealand. [18] (10.1016/j.injury.2026.113198)
• [L1] Initial cast immobilization with fixation for nonunion is the optimal form of treatment for adults with a scaphoid waist fracture, as the small quality-adjusted life year gains for those who underwent surgery initially were not sufficient to justify the higher costs. [19] (10.1302/0301-620x.108b1.bjj-2025-0116.r1)
• [L1] Use of the aid in practice was feasible. [20] (10.1016/j.arth.2025.05.104)
• [L3] Athletes who underwent UCL repair with internal brace reported excellent midterm PROs statistically similar to those after UCL reconstruction, including proportion successfully returning to preinjury sport. [22] (10.1177/03635465251314054)
• [L3] The embrace technique yielded equivalent outcomes compared with suture button fixation for managing syndesmotic injuries. [23] (10.1186/s13018-025-06620-3)

References¶

[1] Regarding “Sling Is Not Inferior to Brace Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial”. Arthroscopy. 2026. DOI: 10.1002/arj.70326

[2] Do patients with minimally displaced distal radial fractures need a plaster cast?. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b1.bjj-2024-0634.r1

[3] Short-term Outcomes of the Cross Brace Protocol for ACL Rupture Management: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967126s00013

[4] Effectiveness of Proximal Interphalangeal Joint Orthosis and Therapeutic Exercise in the Management of Trigger Finger: A Prospective Case Series. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101038

[5] Adequately Reduced Distal Radial Fractures in Elderly Patients: How Long Should We Immobilize?. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.25.00333

[6] Efficacy of Splinting in Managing Adult Trigger Finger: A Systematic Review of Short-Term Outcomes. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100881

[7] PS2 The effect of kinesiotaping with exercise therapy for the treatment of shin splints: a case report. Injury. 2013. DOI: 10.1016/s0020-1383(13)70151-7

[8] Supportive bandage, removable splint, or walking casts for low-risk ankle fractures in children: a feasibility randomized controlled trial. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b1.bjj-2024-0354.r1

[9] Outcome analysis of conservative treatment of a distal radius fracture with OPTIVOhand orthosis versus plaster cast: a randomized controlled trial. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09585-4

[10] Three-week immobilization vs. no immobilization in primary reverse total shoulder arthroplasty: a randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.015

[11] Radiological outcome of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture: five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0125.r1

[12] A randomized comparative trial: Relative motion vs metacarpophalangeal joint blocking orthoses for trigger finger management. Journal of Hand Therapy. 2026. DOI: 10.1016/j.jht.2025.05.018

[13] Waterproof casts for the management of upper limb fractures in children. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b6.bjj-2025-0011

[14] Clinical effectiveness of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture: five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0122.r1

[15] Achieving a balance between mobilization and immobilization after surgical or conservative treatment of the hand. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934251413908

[16] The current state of 3D-printed orthoses clinical outcomes: a systematic review. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09070-4

[17] Mid‐frequency electrical muscle stimulation during immobilization may prevent early deltoid muscle atrophy and promote early strength recovery after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70303

[18] Delivering psychosocial care and support in traumatic injury follow-up: A qualitative study of clinician’s experiences.. Injury. 2026. DOI: 10.1016/j.injury.2026.113198

[19] Cost-effectiveness of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture: five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0116.r1

[20] A Codesigned Patient Decision Aid Supports the Decision Quality of Patients Considering Total Knee Arthroplasty: A Randomized Controlled Trial. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.104

[22] Clinical Outcomes of Ulnar Collateral Ligament Repair With Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251314054

[23] Outcomes of suture button fixation versus embrace fixation for syndesmotic injury. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-025-06620-3