Types of orthopedic arm splints, differences from plaster, how to apply them

Orthoses for the wrist joint are orthopedic products designed to create complete or partial immobility (immobilization) of the damaged area. In essence, they act as plaster. However, modern retainers have a number of advantages over traditional ones - both from an aesthetic and practical point of view.

The use of wrist orthoses allows you to firmly fix the problem area and minimize the load on the injured area. At the same time, the ability to perform simple daily activities is maintained. Thanks to these properties, innovative orthopedic products are indispensable for both therapeutic and preventive purposes. They are widely used for wrist fractures, sprains and ligament ruptures, diseases and pathological conditions of the wrist bones, and are also widely used in the postoperative period.

What are they made from?

There are many types of retainers, which are classified not only by purpose and degree of rigidity, but also differ in composition. The ideal option for immobilizing the wrist joint are orthoses made of low-temperature plastic. This material is completely safe for humans and does not cause allergic reactions.

The functionality of thermoplastic is achieved by heating in the temperature range from 65 to 100°C. After cooling to an average of 40°C, the orthosis is modeled on the body, exactly repeating its contours. The temperature regime at which the product is corrected does not cause discomfort to the patient.

Within 5-7 minutes the material completely hardens and acquires high strength. Despite their lightness, thermoplastic orthoses reliably hold the injured area in the required position.

ORTHOPEDIST-TRAUMOTOLOGIST

Associated damage.

50% of these fractures are intra-articular and may be accompanied by damage to the distal radioulnar joint, in 40% of cases there is damage to the triangular cartilage, in 30% there is damage to the scapholunate ligament, in 15% of cases to the lunate-triquetral ligament.

Classification of radial fractures in a typical location.

Fernandez classification

And of course, everyone’s favorite AO classification.

The AO classification is very detailed; within each group, as a rule, there are 3 more subgroups, and ultimately it covers almost the entire possible variety of fractures of a given anatomical region.

Outpatient physicians often tend to simplify the approach to treatment and often do not even inform patients about possible complications and functional outcome. For this reason, initially extremely unstable fractures can be treated conservatively and heal in a deliberately incorrect position, which can cause the development of arthrosis and persistent limitation of limb function. When we are talking about an elderly patient with low functional demands, this may be acceptable and even desirable, so as not to expose the person to unnecessary operational risks in order to obtain a result that is not particularly needed in this category of patients. But when we are talking about young patients who have a long working life, playing sports and much more, the choice of tactics to obtain the optimal result becomes fundamentally important.

Good treatment results depend on many factors: 1) restoration of the articular surface 2) restoration of normal anatomical relationships 3) early movements in the joints of the hand and wrist joint.

Compliance with these principles can be achieved both conservatively and surgically, but conservative treatment has a number of limitations.

Indications for conservative treatment are extra-articular (extra-articular) fractures with shortening of no more than 5 mm and angular deformation of no more than 20 degrees. Such fractures can be stabilized in a plaster cast and are not characterized by secondary displacement. All other types of fractures (and they are the majority) are prone to secondary displacement in the cast, and multiple re-casting will not correct the situation. Of course, if the patient has firmly decided to refuse surgery despite possible complications, then treatment is carried out using the method of plaster immobilization.

Surgical methods include 1) closed reduction and percutaneous fixation with pins, 2) closed/minimally open reduction and osteosynthesis using external fixators, 3) open reduction and external osteosynthesis using plates and screws.

Indications for surgical treatment are contraindications for conservative treatment: shortening of more than 5 mm, angular deformation of more than 20 degrees, intra-articular fractures, comminuted fractures with defects of the volar or dorsal cortical plates.

Product properties

Doctors and patients increasingly prefer plastic orthopedic structures, which is explained by the high efficiency of modern technologies. Such devices have unique properties, due to which they are widely used in sports medicine, pediatric orthopedics and other industries.

Thus, orthoses made of low-temperature plastic:

• create complete rest of the joint;
• distribute the load over the damaged area;
• help reduce pain;
• shorten the recovery period;
• have a “breathing” effect.

Orthopedic braces promote proper bone healing. The progress of treatment can be controlled - thermoplastic transmits x-rays. If necessary, the product can be corrected.

Etiology of radial fractures in a typical location.

In most cases, this is a fall supported by a straight arm; in the case of young patients, high-energy trauma, falls during sports, from bicycles or other rolling devices, and road traffic accidents are more common. In patients over 50 years of age, especially women, fractures of the distal radius are more often of a low-energy nature and occur due to osteoporosis. Low-energy fractures of the distal metaepiphysis of the radius are an indication for densitometry and subsequent consultation with an endocrinologist and significantly increase the risk of subsequent osteoporotic fractures.

Why choose a wrist orthosis made of low-temperature plastic

Compared to classical immobilization methods, thermoplastic structures have a neat appearance and low weight, so they are successfully used in pediatric orthopedics. The possibility of choosing a colored wrist orthosis is especially attractive to young patients.

In addition, modern orthopedic products have a number of other advantages:

• Do not stick to hair and skin during modeling.
• Prevents the occurrence of bedsores and abrasions.
• They have an affordable price.
• Hypoallergenic, do not emit toxic substances.
• Easily and quickly formed on the body (the whole process takes less than 10 minutes).
• Provide a tight fit without additional padding.
• They do not require special hygienic care; they can be wetted and treated with detergents.
• They retain their shape for a long time.

It is also possible to correct the orthosis in fragments with local heating of the material. For example, such a need may arise after swelling has decreased. Plastic products can be modified with Velcro fasteners and tapes. Clothes can be worn over the orthoses.

Surgical treatment of radial fractures in a typical location.

Closed reduction and percutaneous fixation with pins.

It can maintain reposition in the sagittal plane and lengthwise while maintaining the cortical plate along the palmar surface. With a comminuted fracture and compression of the bone along the palmar cortex, the reduction cannot be maintained.

The Kapandji technique and the Rayhack technique are used, in which reposition is performed under arthroscopic control.

82-90% excellent results when used according to indications.

External fixation.

If only an external fixator is used, it is impossible to restore normal palmar angulation of the articular surface.

For this reason, it is often used in combination with pins, spokes and in some cases with plates.

The external fixator uses ligamentotaxis to stabilize the fracture. It is better to place external fixator pins on the radius under direct visual control to avoid damage to the superficial branch of the radial nerve. When creating distraction, you should not “overstretch” the joint; the joint space should not be more than 5 mm. Also, you should not excessively retract the hand to the ulnar and palmar side, since in case of splinter damage to the palmar cortex, this will still not allow placing the articular surface at the correct angle.

Immobilization time should not exceed 8 weeks and the external fixator should not interfere with early movement of all fingers.

Complications of external fixator: 1) possible non-union of the fracture due to insufficient stability, 2) stiffness of the wrist joint and decreased grip strength 3) infection at the insertion site of the pins 4) reflex sympathetic dystrophy 5) iatrogenic damage to the superficial radial nerve 6) median nerve neuropathy

Open fracture treatment with internal fixation.

Displacement of the articular surface more than 2 mm, Barton-type fractures. Compression of the cortex along the palmar surface, “depressed” fractures of the articular surface.

Surgical technique.

Currently, volar plates are preferred. Modern plates are thin, pre-curved according to normal anatomy, and lockable screws allow for stable fixation even in severe cases when there is a bone defect in the metaphyseal zone and the epiphysis is represented by a thin strip of bone.

To prevent CRPS (complex regional pain syndrome), the current recommendation is Vitamin C 200 mg daily for 45 days after injury.

Clinical example of treatment of a fracture of the distal metaphysis of the radius using open reduction and osteosynthesis with a plate.

How to choose a wrist orthosis

To correctly select a brace for the wrist joint, it is necessary to measure the circumference of the wrist in centimeters with a measuring tape (tightly, but without tightening). Based on the results obtained, select an orthosis using the size selection table:

Important! If it is not possible to measure the circumference of the injured arm, for example it is in a cast, then you can measure the healthy arm.

ORDEKT wrist orthoses are a modern alternative to traditional immobilization methods. You can find out more about these products and see the range of the entire line of low-temperature plastic orthoses on our website. To get specialist advice, call 8 800 500 8333 or write a message online in the feedback form.

The article was checked by Strakhov Maxim Alekseevich - Candidate of Medical Sciences, Associate Professor of the Department of Traumatology-Orthopedics and Military Field Surgery of the Federal State Autonomous Educational Institution of Higher Education Russian National Research Medical University named after. N.I. Pirogov of the Ministry of Health of Russia, Associate Professor of the Department of Traumatology and Orthopedics of the Federal State Budgetary Institution Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia (Moscow).

Conservative treatment of radial fractures in a typical location.

Plaster immobilization for a period of 4 to 6 weeks depending on the morphology of the fracture, the age of the patient, and the presence/absence of osteoporosis. For simple fractures of the distal radius, when plaster immobilization provides adequate stability after 4 weeks, you can begin to develop active movements in the wrist joint. When plaster immobilization is used to treat comminuted, unstable, intra-articular fractures as a necessary measure, for example, when refusing surgery, immobilization should be longer, since there is a risk of fracture nonunion and the formation of a pseudarthrosis.

If during the first reposition it was not possible to achieve a normal position of the fragments, such a fracture will most likely displace in the future.

Possible complications of plaster immobilization include acute carpal tunnel syndrome and complex regional pain syndrome (when plaster immobilization is applied against the background of severe edema).

Features of the metacarpal bones

Our hands have as many metacarpal bones as there are fingers—usually five on each hand. These bones occupy most of the surface of the palm. On the dorsum of the hand, the metacarpal bones can be easily felt under the skin and are separated from it only by a thin layer of fatty tissue and tendons. Each metacarpal bone consists of a head (knuckle), a body (shaft) and a base.

The 1st metacarpal bone plays a special role: it has maximum mobility and moves in different directions. The remaining metacarpal bones are not as mobile. And if the 4th and 5th bones still retain a certain range of motion, then the 2nd and 3rd are firmly connected to the wrist. In this case, a more mobile bone with an incorrectly healed fracture can compensate for the angular curvature by movement, but for a stationary bone, a deviation of even a few degrees becomes fatal.

Types of typical injuries

After an injury, one or more bones may break; damage to the head, diaphysis, or base of the bone may occur. The weakest zone of the 2nd-4th metacarpal bones is the so-called neck, located under the head of the bone. It is this that breaks under load along the longitudinal axis. If the load has a rotational moment, a spiral fracture is formed; if there was direct pressure across the bone, a transverse fracture occurs.

The most common fracture is the subcapitate fracture of the 5th metatarsal bone. This injury is also called a boxer's fracture because the mechanism usually involves a forceful punch to a hard surface. The head of the bone is “folded” in the palmar direction or driven into the diaphysis. Sometimes, in addition to the 5th, other bones of the hand can break in this way.

Any injury to the 1st metacarpal bone is difficult to endure, since it is this bone that ensures the mobility of the thumb. Each type of fracture of this bone even has its own name, for example, Rolando, Bennett, Winterstein fracture. An incorrectly healed or non-healed fracture of the base of the 1st metacarpal bone completely “turns off” the ability to make precise movements and grip strength.

What is the difference between a plaster splint and regular plaster?

Injury or relapse of articular pathology requires immobilization of the hand, preventing the involvement of healthy tissue in the inflammatory process. Previously, ordinary plaster was used for this, which was applied to the entire surface of the limb. In this way, complete immobilization was achieved, but many inconveniences arose:

• firstly, the design is heavy and interferes with normal movement and basic hygiene procedures;
• secondly, it is difficult for doctors to control the effectiveness of treatment, for example, the correct fusion of bone fragments. On the obtained radiographic images, the outlines of bones, cartilage, and synovial bursae are difficult to discern.

Plaster splint.

But the main disadvantage of a regular cast is that it completely immobilizes the arm. In this state, the muscles do not work, which causes their partial or complete atrophy - reduction in size and dysfunction. After removing the cast, patients need to quickly develop their arm to speed up recovery, but with muscle atrophy this is almost impossible. Therefore, after the invention of the plaster splint, doctors rarely use ordinary dry plaster. This orthopedic device has many advantages:

• After tissue restoration, the structure can be easily removed. There is no need to cut the plaster with special scissors or carry out other complex and time-consuming manipulations during removal;
• The doctor can remove the splint for examination at any time. If the result is unsatisfactory, this helps to adjust therapeutic regimens;
• the ease of removing the structure from the hand allows, if necessary, to quickly conduct a diagnostic study - ultrasound, MRI, CT, radiography;
• it is possible to apply pharmacological preparations for external use under the bandage - aseptic solutions, ointments, gels, balms;
• the patient, with the permission of the doctor, can remove the splint and wash the skin with warm water and soap.

A finger splint for a fracture or dislocation.

The gypsum structure has another advantage over conventional gypsum - lightness. This is especially true for fractures or dislocations of fingers, gout attacks. When a regular cast is applied, adjacent fingers are immobilized. And only damaged phalanges are immobilized with a splint. The orthopedic device does not fit tightly to the surface of the skin and does not compress it. Therefore, during its use, injury to healthy tissues by inflammatory edema does not occur.

Plaster for a broken wrist.

How to apply a plaster splint

It is impossible to predict the place and time of injury. A fracture of the radius or wrist, damage to the ligamentous-tendon apparatus occurs in the country, on a hiking trip. The victim requires immediate hospitalization to a hospital for examination by a traumatologist and treatment. If a lot of time passes from the moment of injury to the provision of medical care, then the inflammatory swelling spreads, and displaced fragments damage healthy tissue when moving. This type of development can be prevented if there is a pack of plaster bandage in your first aid kit. If you have the skills, you can apply a temporary plaster splint to your finger or forearm.

This is how a plaster splint is applied.

After delivering the victim to the emergency room, the doctor will examine the X-ray images and determine further treatment tactics. Having compared the bone fragments if necessary, he applies a splint for long-term wearing according to all the rules:

• moistens the plaster bandage in water, squeezes it lightly and lays it on a surface treated with antiseptic solutions;
• cuts a piece of the required length in accordance with the type of injury and the size of the damaged area of ​​the hand, and be sure to smooth out the dressing material so that even the smallest wrinkle does not remain;
• Apply several more layers on top of the bandage - from 10 to 12, carefully removing folds;
• the resulting multilayer material is applied to the skin, lubricated with medical Vaseline, pressing tightly to its surface;
• Leave for 15-20 minutes until completely hardened.

The plaster splint is applied to as small a surface as possible. For example, with fractures of the radial bones, only 60-70% of its length is closed. This is quite enough for reliable immobilization, since it is performed in a bent position at an angle of 90 degrees.

When forming the bandage, the doctor uses special medical instruments and places sterile cotton swabs under the plaster bandage to prevent chafing. The last stage of the procedure is fixation with a regular bandage immediately after the plaster layer has hardened. The doctor makes several turns, trims the end, tucks it in or ties it in a knot.

The technique of applying a splint to the little finger is approximately the same as when fixing the elbow or wrist. One of the differences is the smaller number of layers of plaster bandage (about 7). After the bandage hardens, the patient remains in the emergency room for some time and monitors the condition of the finger. If it hurts, the skin has acquired a bluish tint, numbness and (or) tingling is felt, then the splint is applied again.

The victim is immediately discharged home for further treatment. For the convenience of wearing a plaster splint, you can use a scarf bandage. You should not move your fingers in the first days to avoid displacement of bone or cartilage structures. Doctors recommend performing passive movements for 4-5 days, and after a couple of weeks you can start doing therapeutic exercises.