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Upper limb splinting workshop
- 1. First line splinting solutions for hand and upper limb trauma Ms Avanthi Mandaleson MBBS, BMedsci, FRACS, FAOrthA, Hand Surgeon
- 2. Learning Objectives • Assess common upper limb trauma injuries requiring immobilisation • Identify available splinting options • Understand safe splinting positions • Practice and refine splint application techniques
- 3. Common Injuries • Hand - POSI splint • Flexor tendon injuries • Phalangeal/Metacarpal fractures • Hand - Finger splints • Mallet injuries • PIPJ dislocations • Hand - Long opponens splint • Skiers thumb • Basal thumb injuries • Wrist - resting splint • Scaphoid fractures • Scapholunate ligament injury • Distal radius fractures • CMC fracture dislocations • TFCC tears • Elbow - Above elbow backslab • Elbow fractures/dislocations
- 4. POSI splint Splint position Position of safety (POSI) Volar backslab Indications All metacarpal/phalangeal fractures Flexor/extensor tendon injury Wrist 0-30’ extension MCPJ 70-90’ flexion IPJ Full extension Rationale Collateral ligaments tensioned Avoid stiffness Splint options Plaster Dynacast
- 5. Finger splints Splint position Mallet splint - dorsal position Indications Extensor lag DIPJ - mallet injury DIPJ Full extension PIPJ Unrestricted Rationale Distal phalanx elevated to tendon/bone Avoid hyperextension to minimise joint subluxation Splint options Zimmer splint Thermoplastic
- 6. Conservative mx of bony mallet
- 7. Finger splints Splint position Buddy splint to appropriate adjacent finger Dorsal blocking splint Indication PIPJ dislocations IPJ Collateral ligaments protected by adjacent finger Volar plate protected from hyperextension Rationale Allows early protected motion of stable fractures Minimises swelling Splint options Rigid tape (leukoplast/elastoplast) Zimmer splint
- 8. PIPJ dislocations Mechanism Jammed finger against ball or ground Presentation Finger deformity - unable to flex PIPJ Injury pattern Simple dislocation or fracture dislocation - axial traction reduction Ix XR Radiology findings Exclude significant fracture (base P2) Confirm reduction When to refer Early referral < 1 week if unable to move Treatment Simple stable - buddy strap and move (+/- dorsal blocking splint)
- 9. Thumb splints Splint position Long opponens/Thumb spica Position of function Indications Thumb trauma Skiers thumb (MCPJ) Wrist Immobilised 0-30’ extension MCPJ 30’ flexion IP joint +/- immobilisation (extension) Rationale Pain relief Reduce swelling Allow reassessment of stability < 1week When to refer Early referral < 1 week if unable to move Unstable on XR Splint options Plaster Dynacast
- 10. Wrist splints Splint position Volar resting backslab Indication Wrist and scaphoid fractures Scapholunate and ulnar sided wrist injuries Wrist Immobilised 30’ flexion- 30’extension Avoid extreme wrist position MCPJ Free (splint proximal to distal palmar crease) Rationale Functional splint position Allows wrist and scaphoid immobilisation Prevents finger stiffness Minimise risk of CRPS Plaster
- 11. Elbow splints Splint position Above elbow backslab Indication Elbow fractures/dislocations Elbow 70-90’ flexion Wrist Free or immobilised in functional position Rationale Functional splint position Maintains reduction Pain relief Splint Plaster
- 12. Principles of upper limb trauma splinting • Finger injuries - prone to swelling and stiffness • Treatment - early stabilisation, oedema management and early active ROM • Protect against at risk positions • Wrist and elbow • Functional position • Avoid tight splints and extreme position
- 13. Summary • Recognise injuries that require splinting • Understand safe splinting positions • Low threshold for XR - referral timing • Early referral - Therapy or surgical repair • Wrist injuries - if no fracture and don’t settle <2 weeks, MRI or referral • Early diagnosis - early treatment - early return to function
- 14. How to refer? Avanthi Mandaleson Hand Surgeon Mob: 0487 208 655 avanthimandaleson@icloud.com Private Consulting: Heidelberg Surgical Level 7, 10 Martin Street Heidelberg T: 9456 9077 F: 9456 9177 TAC/Workcover welcome ADF welcome Services: Hand therapy on site Aims to provide review and treatment plan within 48hrs Public: Department of Orthopaedic Surgery Austin Health Division of Hand Surgery Orthopaedic Department Dandenong Hospital, Monash Health