=== Splint Donning and Doffing ===
=== Splint Donning and Doffing ===
== References ==
== References ==
Distal radius fractures with dorsal angulation (also know as Colles Fractures) are usually the result of a fall on an outstretched hand. In children and young adults, the force required for this sort of fracture is much higher (eg a fall off monkey bars or a car accident) whereas in older adults, distal radius fractures tend to occur following a low energy trauma (e.g. a fall from a standing height). In younger populations, males are more likely to sustain this sort of fracture. In older populations, it is more common in females. There is also a correlation with osteopenia in older adults.
Many distal radius fractures are managed conservatively, but a number will require surgical fixation. You can read detailed post-operative protocols for Colles’ fractures fixed with open reduction internal fixation (ORIF) here (0-6 weeks post-op) and here (beyond 6 weeks post-op).
Because inadequate management of distal radius fracture can result in chronic wrist pain, reduced mobility, and, impact hand function, it is essential that these fractures are treated appropriately. While a recent review and meta-analysis of surgical treatments found no clinically important differences between various surgical options for functional outcome one years post-surgery, the authors of this study noted that:
- Volar plating was associated with fewer complications, particularly for individuals who had intraarticular fractures
- Nonbridging external fixation was associated with fewer complications for individuals who had extraarticular fractures
- Non-operative treatments may still be preferred for individuals more than 60 years old
Patients who are managed with ORIF will need a volar distal orthosis fitted day one post surgery. These splints are preferable to a circumferential splint as they are easier to take on and off. As this patient group has had ORIFs to stabilise their fracture, there is no need for them to be fully immobilised. The splints are primarily used for protection (i.e. in case of fall or a blow to wrist).
Here we outline a simple method of fabricating this splint:
- Thermoplastic sheet in basic rectangle template – length is based on the distance from the patient’s MCP joints to around two thirds of the length of the his/her forearm
- Frying pan
- Splinting sheers
- Egg flipper
- Looped Velcro straps x 3
- Sticky backed hooks x 3
- Take the thermoplastic sheet and place it into hot water in the frying pan. This will make it soft and malleable. Please check the temperature before putting the sheet onto the patient’s skin to avoid burns.
- Once the thermoplastic sheet is softened enough, cut the thumb hole. First pierce the material with your scissors and cut out a small circle. As a general rule, the thumb hole should be around 3cm from the top of the sheet and 3cm in from the side (see figure 1).
- Place the thermoplastic sheet back into the warm water and roll out the edges of the thumb hole to make sure it will be comfortable and smooth when worn (see figure 2).
- Place the splint on your patient’s hand. Hook the thumb hole around their thumb and mould the plastic around their forearm and through the curvature of their hand. It is best if you sit opposite your patient, with their elbow resting on the table (see figure) Remember to check that:
- The end of the splint is below the MCP crease distally, so the patient will be able to achieve full finger flexion
- The area between the thumb and index finger is flat and thin, so that the thumb won’t get any pressure areas, when moving into abduction
- The thumb area is large enough to ensure that there is no rubbing on the CMC joint and to achieve full opposition between thumb and little finger
- The patient is in slight wrist extension when fitting the splint – usually 10-15 degrees
- Once the plastic has dried and hardened (which usually occurs very quickly), the splint is ready to be trimmed down to fit the patient. Remember the splint should reach 2/3 of the forearm length and the sides should be trimmed so that the splint sits at around ¾ depth of the forearm.
- Flare out the area around the ulnar styloid to avoid any pressure/rubbing in this area.
- Place the splint back into frying pan, so that you can roll the bottom and top edges to make it smooth on the edges for comfort (see figure 2).
- Add velcro straps to the splint, starting with the most distal strap (which should be the thinnest strap at 2cm wide). This strap should be positioned on a slight diagonal angle (i.e. place it on a downward tilt). For longevity of the splint, try using a heat gun to heat the backing of the hook onto the splint.
- Add the middle strap (which should be 3cm wide) straight across the back of the wrist.
- The final strap rests at the proximal end of the splint. This strap should be positioned on a slight upward angle, so that it will sit flat when the splint is applied (see figure 4).
- Place the splint on the patient’s arm. Remember to check:
- The distances at the MCP
- That the splint clears the CMC joint
- That the wrist is slightly extended
- That the straps are firm, without being too tight (see figure 5)
- Trim the straps down to fit the patient. Round the edges of the straps and Velcro hooks to stop them catching on clothing.
- It is often useful to provide tubigrip or a splint sock that is worn under the splint to reduce rubbing/sweating. This will help with comfort and may increase compliance around splint use.
Informed consent[edit | edit source]
Clinician should explain the procedure to the patient followed by obtaining a written or verbal consent. The patient must be willing to partner with healthcare team in the care plane that included wearing the splint. The explanation given to the patient and caregiver should include, but should not be limited to the following information:
- reason for choosing this type of splint
- risk, benefit and possible complications of wearing the splint
- skin and splint care
- the splint wearing schedule
Skin Care[edit | edit source]
Splint Care[edit | edit source]
Potential Complications[edit | edit source]
The possible complications of wearing the splint, or the consequences of not wearing the splint as recommended must be explained to the patient before the splint is applied. This information should be included in the informed consent and/or written instructions given to the patient or the caregiver. These potential complications include the following:
Splint Donning and Doffing[edit | edit source]
You can provide the patient with discharge instructions which should include the following information:
Caring for Your Splint
You have received a volar extension splint. This splint helps to protect your wrist in case of the fall or direct blow to the wrist. You must care for the splint and prevent it from being damaged. The damaged splint will no longer be appropriate for wearing. Take good care of your splint. If your splint becomes damaged or loses its shape, you need to contact the clinic as it more likely need to be replaced.
You have a broken bone in your forearm. The bone was repaired with a procedure called ORIF (open reduction, internal fixation) and the doctor prescribed a splint for you to be worn daily for________days
- Wear your splint according to the instructions you received.
- Keep the splint dry at all times. Tape two layers of plastic to cover your splint when you take a shower or bath, unless your doctor or therapist said you can take it off while bathing.
- If you need to keep the splint on during hygiene, bathe with your splint, but hold protected with plastic bag outside the tub or shower when bathing. Use two layers of plastic closed at the top end with a rubber band to protect the splint from getting wet. Or you can buy a waterproof shield.
- If your splint gets wet, dry it with a hair dryer on the “cool” setting. Do not use the warm or hot setting, because you can burn your skin.
- Always keep the splint clean, away from dirt and away from open flames.
- Wash the Velcro straps and inner cloth sleeve if provided (stockinet) with soapy water and air dry.
- Do not expose your splint to heat, space heaters, or prolonged sunlight. Excessive heat will cause the splint to change shape.
- Do not cut or tear the splint.
- Elevate the part of your body that is in the splint. This helps reduce swelling.
Make a follow-up appointment with your healthcare provider, or as advised.
You need to call your healthcare provider if:
- You experience tingling or numbness in the affected area
- You have a severe pain that cannot be relieved with medicine
- The splint feels too tight or too loose
- You observe swelling, coldness, or blue-grey colour in the fingers or toes
- The splint becomes damaged, cracked, or has rough edges that hurt
- You notice pressure sores or red marks that do not go away within 1 hour after removing the splint
- Blisters are present
If you experience any of the above symptoms or have questions related to splint wear and care, please call us at…………………….
Please modify these instructions to meet the needs of your patient and caregiver.
- Fahy K, Duffaut CJ. Hand and wrist fractures. Curr Sports Med Rep. 2022 Oct 1;21(10):345-6.
- Handoll HHG, Huntley JS, Madhok R. External Fixation versus conservative treatment for distal radial fractures in adults (Review). The Cochrane Library. 2008;4:1-78
- Candela V, Di Lucia P, Carnevali C, Milanese A, Spagnoli A, Villani C, Gumina S. Epidemiology of distal radius fractures: a detailed survey on a large sample of patients in a suburban area. J Orthop Traumatol. 2022 Aug 30;23(1):43.
- Azad A, Kang HP, Alluri RK, Vakhshori V, Kay HF, Ghiassi A. Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups. J Wrist Surg. 2019;8(4):305-11.
- Lim JA, Loh BL, Sylvestor G, Khan W. Perioperative management of distal radius fractures. J Perioper Pract. 2021 Oct;31(10):1750458920949463.
- Dehghani M, Ravanbod H, Piri Ardakani M, Tabatabaei Nodushan MH, Dehghani S, Rahmani M. Surgical versus conservative management of distal radius fracture with coronal shift; a randomized controlled trial. Int J Burns Trauma. 2022 Apr 15;12(2):66-72.
- Zhang P, Jia B, Chen XK, Wang Y, Huang W, Wang TB. Effects of surgical and nonoperative treatment on wrist function of patients with distal radius fracture. Chin J Traumatol. 2018;21(1):30-3.
- Woolnough T, Axelrod D, Bozzo A, Koziarz A, Koziarz F, Oitment C et al. What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Clin Orthop Relat Res. 2020 Nov 3. Epub ahead of print.
- Thorn, K. Introduction to distal radius fracture [VIMEO]. Queensland: Physiopedia, 2019.
- Foster BD, Sivasundaram L, Heckmann N, Pannell WC, Alluri RK, Ghiassi A. Distal Radius Fractures Do Not Displace following Splint or Cast Removal in the Acute, Postreduction Period: A Prospective, Observational Study. J Wrist Surg. 2017;6(1):54–59.
- Andrade-Silva FB, Rocha JP, Carvalho A, Kojima KE, Silva JS. Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial. Inquiry. 2019;50(2):386-391.
- Garcia-Rodriguez JA, Longino PD, Johnston I. Forearm volar slab splint: Casting Immobilization Series for Primary Care. Can Fam Physician. 2018 Aug;64(8):581-583.
- Bethel CA, Meller MM. Volar Splinting. [Updated 2023 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482429/ [last access 13.11.2023]