Rehab

Question 1

Mallet splint

i) Indication
ii) Types
iii) how to use
iv) improper usage

Answer 1

i) Indication
-Splinting is the most common initial treatment method for soft tissue or bony mallet finger.

ii) types
- Mallet splint is an extension splint
plastic stack splints, thermoplastic, and aluminum form splints.
volarly placed is better
free the PIPJ to allow movement

iii) how to use
- full time splinting for 6 weeks, followed by 2–6 weeks of splinting at night
-should be used continuously and the DIP joint should be maintained in full extension even during skin hygiene care
-Patients should be instructed on how to change the splint for periodic cleaning and examination of the skin without allowing the DIP joint to flex.

iv) incorrectly used
a) Residual terminal extensor lag
- incorrect treatment can lead to DIP joint dysfunction.
- if not fully extended: 1 mm lengthening of the terminal extensor tendon results in 25 degrees of extension lag
- if hyperextended: shortening of 1 mm will seriously restrict DIP joint flexion

Question 2

Mallet finger treatment indication
1. Non-operative
2. Operation

Answer 2

1) Non-operative
- acute soft tissue injury (< than 12 weeks)
- small (~25%)
- minimally displaced bony mallet injury without joint subluxation

2) Operative
-Open injuries.
- Bony mallet with a large fragment and subluxation of the DIP joint.
- Unstable fractures (30–50 % of the joint surface involved).
Intolerance to splints.
- Chronic injuries (older than 12 weeks).
- Painful arthritic DIPJ.
- Swan neck deformity.

Question 3

1. Name this orthoses.
2. Describe its features.
3. Describe its usage.
4. Explain its biomechanics
5. What is a disadvantage of this AFO
6. Contraindication for use

Answer 3

1. Posterior leaf spring orthosis
2. Features:
   - made of plastic or carbon fibre.
   - PLSO has a characteristic trimline located behind the ankle (at malleolus) and has a leaf-shaped corrugation near the ankle.
   - The leaf-like creases are intended to strengthen the part of the ankle with the most amount of movement and repeated loadings. The creases act as a spring in the ankle that allows slight dorsiflexion in the mid and terminal stances, and this elasticity can also marginally assist the push-off function in the terminal stance.
3. Clinical usage
   - is used in the presence of motor weakness in the ankle dorsiflexor caused by conditions such as cerebral palsy and stroke.
   - in Orthopaedic: common peroneal nerve palsy

Compared to Solid AFO:
i) Owing to its greater elasticity and flexibility than those of regular SAFO, PLSO is suitable for patients
- with mild cramps
- who are more active
- with better balance than those for whom SAFO is used

ii) as the ankle trimline extends further to the front of the ankle joint, the effectiveness in controlling the instability of the ankle increases.

4. Biomechanics

i) Swing: PLSO reduce excessive ankle plantarflexion by keeping it in dorsiflexion during swing phase to facilitate clearance of the toes from the ground during swing phase.

ii) Stance: Preposition foot for initial contact by heel

Disadvantages:
- does not contribute significantly to ankle stability, as the trimline is behind the ankle so has limitation in controlling valgus/varus.

5. Contraindications:
   - Mod-severe hypertonicity
   - Moderate to severe spasticity
   - Coronal plane ankle instability (varus, valgus)
   - ankle dorsiflexion limitations/fused joint (rigid equinus)
   - severe knee instability

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392067/