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PHTY3120 > L30a: Splinting of Hand & Wrist > Flashcards

L30a: Splinting of Hand & Wrist Flashcards

1
Q

What are the 6 aims of splinting?

A
  1. Facilitate healing
  2. Protect healing
  3. Maintain optimal anatomical position
  4. Assist weak structures
  5. Restrict ROM
  6. Improve ROM
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2
Q

How does splinting “facilitate healing”?

A

The wound healing process is the basis of splint design and application.

  • Either splint to increase or decrease ROM
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3
Q

What are the 3 healing phases? What are the features (1,2,1)?

A
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4
Q

What splints are suitable for the inflammatory, proliferative and maturation phase?

A
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5
Q

What splint is good for “thumb reattachment with skin graft and muscle flap”?

A

The splint should have no compression on the wound, otherwise the graft and flap will fail. Dorsal based splint is good.

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6
Q

What are 3 features of splints used to “protect healing”?

A
  1. Immobilisation provides external stability until the tissues have regained sufficient strength to withstand normal stresses associated with their function.
  2. As the strength of the wound increased, the need for immobilisation decreases.
  3. The duration of immobilisation is directly related to the tissue strength and function.
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7
Q

What does immobilisation provide?

A

Immobilisation provides external stability until the tissues have regained sufficient strength to withstand normal stresses associated with their function.

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8
Q

As the strength of the wound increased, the need for immobilisation______ (increases/decreases)

A

decreases

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9
Q

The duration of immobilisation is directly related to the_____ and ______.

A

tissue strength; function

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10
Q

What are 5 complications of prolonged immobilisation when “protecting healing”?

A

often a dilemma - need to protect the structures enough to allow repair, but mobilise early enough to prevent secondary complications

  1. Cartilage atrophy
  2. Muscle atrophy
  3. Adhesions between the folds of the synovial lining
  4. Disorganisation of the cellular and fibrillar arrangement of the ligaments and attachments to bone.
  5. Must consider pros and cons of immobilisation
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11
Q

What is the duration of immobilisation when “protecting healing”?

A
  1. Generally do not immobilise the whole 6-8 weeks
  2. Scaphoid fracture is immobilised 8-10 weeks
  3. Other things: e.g. Finger fracture is protected 5-6 weeks till bone heals. Start moving in 3-10 days.
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12
Q

What is the splint suitable for “EPL tendon repair” when “protecting healing”?

A

Splint 6 weeks for protection

  • Allow gliding of EPL tendon to prevent adhesions, and also prevent full thumb F which would rupture the repair.
  • Allow 0-10° F first week, then increase thumb F by 10° every week.
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13
Q

What is the splint suitable for “volar plate injury” when “protecting healing”?

A

Volar plate injury: Splint 3-5 weeks for protection

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14
Q

What is the purpose of splinting to “maintain optimal anatomical position”?

A

Positions of immobilisation of the hand aims to maintain normal anatomical relationships

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15
Q

How can you splint in acute conditions to “maintain optimal anatomical position”? What are the 3 purposes?

A

Splint in the position of safety (POSI)

  1. Facilitate venous drainage
  2. Minimise stiffness of collateral ligaments
  3. Maintain balance of long finger extensors, long finger flexors and intrinsics
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16
Q

How can you splint in chronic conditions to “maintain optimal anatomical position”?

A

Splint in the position of function

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17
Q

How can you splint all joints to “maintain optimal anatomical position”?

A
  • We rarely immobilise all joints. Even if we do, it will only be for a short period of time.
  • Pathology is the overriding factor.
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18
Q

What is the splint to “assist weak structures”?

A

Splints assist active movements. Usually for nerve palsies

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19
Q

What is the splint for ulnar nerve palsy to “assist weak structures”?

A
  • Anti claw splint
  • Allow FDS functions
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20
Q

What is the splint for radial nerve palsy to “assist weak structures”?

A

Rubber band pulls into wrist E

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21
Q

What is splinting for “resist ROM”? What are 3 features?

A

Restriction splints limit a specific ROM, which allows optimal tissue healing whilst facilitating functional use of the limb.

  1. Tissues in the hand glide in relation to each other to allow complex movements. Injuring a single structure is rare.
  2. Complete immobilization will affect the relationship between intrinsic and extrinsic structures.
  3. Controlled active motion maintains gliding of hand tissue, and minimises the complications associated with scarring.
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22
Q

What is the splint suitable for a central slip repaur to “restrict ROM”?

A

Central slip repair. Short arc motion protocol.

  • Finger E splint. 3-5x doff splint per day, 0-10°F exercise.
  • Increase F by 10°every week for 6 weeks
  • After 6 weeks, they should be able to make a full fist
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23
Q

What is the splint to “improve ROM”?

A

Mobilising splints are used to correct deformity through gentle forces, resulting in increased PROM.

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24
Q

What are 6 features of splints to “improve ROM”?

A
  1. Prolonged gentle forces elicit plastic changes in soft tissue length. This depends on the viscoelasticity of the tissues.
  2. The total stress used to modify contracture is a combination of tension and duration. Insufficient stress will have no effect, but excessive stress could cause pain and inflammation.
  3. Low load prolonged stretch is applied to mobilising splints for a total of 6-8 hours per day.
    • Creep effect will elongate the tissue.
    • Work with patients to decide when they can wear splint
    • The 6-8 hours can be intermittent or prolonged wear
  4. Total end range time (TERT) is the total time that the joint is held at EOR to stimulate tissue growth.
    • Mobilising splint is more effective in maximising TERT than other therapeutic interventions.
  5. Timing of splint application is key to managing contractures.
    • No dynamic splint on recent acute injury, as it will be painful and will not get full ROM
    • Yes dynamic splint on FFD or reduced PROM during proliferation phase and early remodelling phase
    • Can convert static splint to dynamic splint
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25
Q

What is low load prolonged stretch to “improve ROM”? What are 3 features?

A

applied to mobilising splints for a total of 6-8 hours per day.

  1. Creep effect will elongate the tissue.
  2. Work with patients to decide when they can wear splint
  3. The 6-8 hours can be intermittent or prolonged wear
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26
Q

What is total end range time (TERT) to “improve ROM”?

A

total time that the joint is held at EOR to stimulate tissue growth.

  • Mobilising splint is more effective in maximising TERT than other therapeutic interventions.
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27
Q

What is the timing of splint to “improve ROM”? What are 3 features?

A

Timing of splint application is key to managing contractures.

  1. No dynamic splint on recent acute injury, as it will be painful and will not get full ROM
  2. Yes dynamic splint on FFD or reduced PROM during proliferation phase and early remodelling phase
  3. Can convert static splint to dynamic splint
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28
Q

What is the purpose of the “hand based finger dynamic splint” to improve ROM?

A

To regain flexion at MCP, PIP, DIP after a metacarpal neck fracture

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29
Q

What is the purpose of the “hand based MCP dynamic splint” to improve ROM?

A

To regain MCP flexion after a metacarpal neck fracture

30
Q

What is the purpose of the “finger based PIP joint static progressive splint” to improve ROM?

A

To correct FFD at the PIP after ORIF of the proximal phalanx.

  • Suture stays in for max 14 days
  • Early scar adhesion to the extensor mechanisms will reduce F/E
31
Q

What is the purpose of the “hand based DIP joint dynamic splint” to improve ROM?

A

To regain DIP flexion

32
Q

What is the purpose of the “hand based thumb IP joint dynamic splint” to improve ROM?

A

To regain IP flexion

33
Q

What is the purpose of the “Collello splint (dynamic splint)” to improve ROM?

A

To regain forearm rotation, commonly supination.

  1. Post-op they need to get 60-70°supination in the first few weeks
  2. If not, we use Collello splint.
  3. Rubber bands pull into supination
  4. Bulky and hard to wear
34
Q

What is the purpose of the “forearm based wrist dynamic splint” to improve ROM?

A

To regain wrist flexion or extension

  • Wrist F EOR may give secondary carpal tunnel syndrome - beware of splint duration.
35
Q

What is the purpose of the “dorsal metacarpal guard” to “promote function”?

A

Allow return to sport but still providing protection.

  • Dorsal metacarpal guard is for 5th metacarpal fracture
36
Q

What is the purpose of the “PUSH brace” to “promote function”?

A

PUSH brace is for 1st CMC joint OA.

  • Low profile splint that provides enough support to allow pain free function.
  • Wear it during flare-up
37
Q

What are 4 classifications of splints?

A
  1. Static Splints
  2. Serial Static Splints
  3. Static Progressive Splints
  4. Dynamic Splints
38
Q

What are 2 features of static splints?

A
  1. Static splints immobilise joints. No moving parts.
  2. Promote healing in inflammatory phase
  • e.g. Volar wrist splint, hand based thumb spica splint, dorsal finger splint.
39
Q

What are 3 features of serial static splints?

A

Serial static splints are changed frequently to accommodate changes is tissue length.

  1. No moving parts
  2. Good for contractures (FFD).
  3. Worn full time. Change every 3-5 days for a few weeks.
    • Check skin integrity at every change
    • Hand cannot get wet
40
Q

What are 3 features of static progressive splints?

A

Rigid splint but changed frequently to accommodate changes is tissue length.

  1. Same as serial static splints, but not circumferential
  2. No moving parts
  3. Holds joint at EOR. Slow progressive mobilisation through low load prolonged stretch.
41
Q

What are 3 features of dynamic splints?

A
  1. Rigid base with dynamic force provided by springs or rubber bands.
  2. Low load prolonged stretch
  3. Controlled stress through dynamic splints influences the collagen growth and alignment.
42
Q

What are 4 descriptions of splints?

A
  1. Basis (location) of splint: Finger based, thumb based, forearm based, hand based.
  2. Articular joint: Elbow, forearm, wrist, hand, finger, thumb
  3. Purpose of splint: Immobilisation, mobilisation, restriction
  4. All together: e.g. Forearm based wrist immobilisation splint
43
Q

What is the Arch System? What are the 3 arches?

A

1 rigid arch & 2 mobile arches contribute to strong functional grasp

  • Longitudinal arch allows flexion of DIP, PIP and MCP.
  • Proximal transverse arch acts as a fulcrum for the wrist and long flexors
  • Distal transverse arch (metacarpal arch) moves through the metacarpal heads.
44
Q

What is the longitudinal arch?

A

Longitudinal arch allows flexion of DIP, PIP and MCP.

45
Q

What is the proximal transverse arch?

A

Proximal transverse arch acts as a fulcrum for the wrist and long flexors

46
Q

What is the distal transverse arch?

A

Distal transverse arch (metacarpal arch) moves through the metacarpal heads.

47
Q

What are 5 skin creases?

A
  1. Distal palmar crease
  2. Proximal palmar crease
  3. Thenar crease
  4. Wrist creases
  5. Digital creases
48
Q

What are 3 features of splinting and skin creases?

A
  1. When splinting to immobilise a joint, you must cover its flexion crease.
  2. When mobilizing a joint, you must expose its flexion crease.
  3. e.g. To immobilise MCP, splint above distal palmar crease. To mobilise MCP, splint below distal palmar crease.
49
Q

What are 3 features of dual obliquity?

A
  1. Length of 2nd-5th metacarpal gradually decreases
  2. 5th metacarpal has more F than 2nd metacarpal
  3. Splint should go down obliquely to ensure comfort for function.
50
Q

What are 4 mechanics of splint?

A
  1. Leverage
  2. Fit/comfort
  3. Strength
  4. Pressure
51
Q

What are 3 features of leverage as mechanics of splint?

A
  1. A lever is a rigid structure that pivots at a fixed point. It is used to affect movement.
  2. Most splints have 3 points of pressure acting on the limb and axis of motion at the joint.
  3. Effective strapping maintains optimum leverage.
52
Q

What are 4 features of fit/comfort as mechanics of splint?

A
  1. Splint must fit appropriately.
  2. Reduce pressure areas by padding/flaring edges: e.g. Ulnar head, radial styloid, dorsal MCP joints.
  3. Cut material hot/rough, flare edges
  4. Thumb area should be slightly loose to avoid irritating the superficial branch of radial nerve.
53
Q

What are 2 features of strength as mechanics of splint?

A
  1. Choose appropriate material for goal
  2. Can reinforce the strength add contours by adding extra material on top.
54
Q

What are 5 features of pressure as mechanics of splint?

A
  1. Signs of pressure: Blanching, change in surface contour, hyperaemia and pain
  2. Prolonged increase in pressure results in ischaemia.
  3. Volar forearm tolerates pressure better than the dorsal hand.
  4. 1st web space is a common pressure site
  5. Pressure = total force / area of force application
    • Avoid high pressure by increasing surface area
    • Splint should cover 2/3 length of forearm. Splint too short may result in pressure area at wrist.a
55
Q

What are 11 essential considerations of splints?

A
  1. Skin
  2. Bony prominences
  3. Friction
  4. Pressure
  5. Oedema: Day 1 post-op, do not make the splint too tight as oedema is expected to increase.
    1. Educate patient what to do if swelling increases (RICE)
    2. Beware if swelling decreases, the splint will be too loose
  6. Circulation: Serial static splints should not be too tight - need to cut open
  7. Sensory loss: Patient is unaware of pressure & friction
    1. Educate them to check for pressure areas & skin integrity
  8. Convenience/cosmesis: Splint should not be too bulky, still functional, comfortable - increase compliance.
  9. Do not immobilise unnecessary joints
  10. Complexity of straps
  11. Ease of maintenance.
56
Q

What are the 4 handling and 4 performance characteristics in the materials of splints?

A
57
Q

What are the 3 thermoplastic materials for splints?

A
  1. Aqua plast
  2. Orfilight
  3. Orit colours
58
Q

What are the 2 uses of aquaplast for splinting?

A
  1. Dorsal blocking splints, large wrist splints, elbow splints
  2. Too thick - no use on old people & children
59
Q

What are the 8 handling characteristics of aquaplast for splinting?

A
  1. Very drapable, contours well
  2. Can mould directly onto the skin
  3. Apply in gravity assisted position
  4. Long working time
  5. 100% elastic memory - can remold 3-4x
  6. Will stretch if overheated
  7. Transparent when reaching moulding temperature
  8. Needs dry heat to self-bond straps
60
Q

What are the 4 performance characteristics of aquaplast for splinting?

A
  1. 3.2mm thickness
  2. Excellent rigidity
  3. Perforated leaves rough edges - needs smoothing to prevent skin abrasion
  4. Perforations provide a varying degree of ventilation and weight.
61
Q

What is the use of orfilight for splinting?

A

Forearm splints, wrist splints, hand/thumb splints

62
Q

What are 9 handling characteristics of orfilight for splinting?

A
  1. Good drapability
  2. Best to use gravity to achieve good fit
  3. Can use bandage to assist moulding without ridging
  4. Self-bonds well
  5. Tacky when heated
  6. Excellent stretch
  7. Moderate elasticity
  8. Moderate memory
  9. Good conformability
63
Q

What are 3 performance characteristics of orfilight for splinting?

A
  1. 2.5mm thickness
  2. Strong
  3. Colours: Blue, black, beige
64
Q

What are 2 uses of orfit colours for splinting?

A
  1. Finger based splints, hand based/thumb splints.
  2. Use on children
65
Q

What are 4 handling characteristics of orfit colours for splinting?

A
  1. Excellent stretch without tearing
  2. Great elastic memory
  3. Easy to trim edges
  4. Great conformability
66
Q

What are 4 performance characteristics of orfit colours for splinting?

A
  1. 2mm thickness
  2. Similar to orfilight but less rigid.
  3. Non-stick coating
  4. Many colours
67
Q

What are 3 splint accessories?

A
  1. Padding: Used over bony prominences or to provide a soft feel
  2. Liners: Tubigrip, tubifast, stockinette, splint socks
  3. Strapping: Secure the splint, providing 3 points of leverage.
    • Adhesive hook Velcro
    • Non-adhesive loop Velcro
68
Q

What are the uses, handling and performance characteristics of aquaplast, orfilight and orofit colour?

A
69
Q

What is involved in informed consent for splinting?

A
  1. Explain purpose of splint
  2. Explain process of making splint
70
Q

What are the 7 processes of making a splint?

A
  1. Pattern: Draw pattern on paper towel, mark landmarks, cut out to test fit on patient’s hand
  2. Refine pattern: Draw pattern on plastic
  3. Options for materials
  4. Cut and heat
    • While waiting for heating, position the patient appropriately, put on liners & padding, warn them it will be hot.
  5. Evaluate fit while molding
    • Use gravity to assist as able
    • Gently apply and mould until plastic cools
  6. Strapping and accessories
  7. Splint finishing touches
    • Flaring edges
    • Ensure proper ROM
71
Q

What are 7 questions in the evaulation of splints?

A
  1. Did the splint accomplish its purpose?
  2. Correct for biomechanical principles?
  3. Correct material?
  4. Consideration of fluctuating oedema?
  5. Cosmetically appealing?
  6. Comfortable and free of pressure?
  7. Functional considerations
72
Q

What are 5 features in the patient education?

A
  1. Purpose of the splint
  2. Precautions regarding pressure
  3. Schedule for wearing splint: When to wear and how long?
    • Showering: Doff splint, or keep it on and wrap with a bag
  4. Give contact details
  5. Splint care: Splint will melt in heat - do not leave it in car

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