its about splinting

1. INTRODUCTION
 Splint and Orthosis
 Mosby's Medical Dictionary (1994) defines
a splint as:
 Splint is an orthopedic device for
immobilization, control, or support of any
part of the body.
 Orthosis is a force system designed to
control, correct, or compensate for a bone
deformity,
 Greek orthosis, meaning “straightening,”

2. CONTINUE
 Third International Dictionary defines splint
as “a rigid or flexible material (as wood,
metal, plaster, fabric, or adhesive tape)
used to protect, immobilize, or restrict
motion in a part.
 Brace refers to “an appliance that gives
support to movable parts (as a joint or a
fractured bone), to weak muscles (as in
paralysis), or to strained ligaments (as of
the lower back).”

3. PURPOSE
 (1) increase function,
 (2) prevent deformity,
 (3) correct deformity,
 (4) protect healing structures,
 (5) restrict motion,
 (6) allow tissue growth or remodeling.
 (7) support
 (8) mobilize

4. CLASSIFICATION OF SPLINT
 Descriptive Classification System
 American Society of Hand Therapist
Descriptive Classification System
A descriptive classification:
 Purpose of splint: immobilizing splint
 External configuration: bar splint, spring splint
 Mechanical characteristic: dynamic and static
 Anatomic part: wrist, finger, thumb
 How/why/where: CMC mobilization splint

5. ASHT
 Wrist cock-up splint=wrist control splint=wrist
support splint
 Inconsistent terminology of splint prevent easy
communication
 Same splint or similar splint may use for different
purpose and different name(moberg).
 Survey done by American hand therapist in 1986
 Meeting in 1991 along with world wise hand
therapist.
 Publication of ASHT in book format 1992
 Function is more essential elements than style and
design of the splint therefore the focus of
classification was on function of splint and
anatomical part upon which they act

6.  ASHT is a comprehensive method which
cater nearly all important aspect of splinting
nomenclature such as anatomical site,
movement and design
 This system describes splint through six
predefined division that guide and
progressively refine splints technical name
from broad concept to individual splint
specification.
 Articular/non-articular, location, direction,
purpose, type, and total number of joint.

7. First division divides into two groups
a) Those affects articular structure and
b) Those affect anatomic segments or structure
but do not affects joint motion.
 Articular- three point pressure systems to
affect a joint or joints by immobilizing,
mobilizing, restricting, or transmitting torque,
and non-articular- two point pressure.
Eg. Humerus splint(non-A)
Elbow splint( A )

8. ASHT
ARTICULAR NON-ARTICULAR
LOCATION LOCATION
DIRECTION
PURPOSE
MOBILISATION RESTRICTION
TYPE TYPE TYPE
IMMOBILISATION

10.  Thumb CMC palmar abduction
immobilization splint,
type 2 (3)

12.  Index–small finger MP flexion and ulnar
deviation restriction splint, type 0 (4)

14.  Ring–small finger MP extension restriction
splint type 0(2)

16.  Wrist neutral immobilization splint, type 0 (1)

17. MATERIALS AND
TOOLS
 Thermoplastic material
 Thermoplastic: low temperature
thermoplastic and high temperature
thermoplastic
 Low thermoplastic are those commonly
used to fabricate splint.
 When it is heated become pliable and then
harden to its original rigidity after cooling.

18.  low temperature thermoplastic: a low
temperature thermoplastic used for
fabrication of splints, braces and adaptive
equipment. Plastics which require no more
than 80°C (180°F) to become workable may
be termed low-temperature thermoplastics.
Adv- easy to handle, provide excellent
strength and rigidity, does not leave
fingerprint, edge trim and roll easily, elastic
memory,
Disadv- does not help in severe tightness
precisely.

19. Cool- 4- 6 minutes
 1.6mm for 30 seconds at 70°C-75°C gives 1
minute working time
 2.4mm for 1 minute at 70°C-75°C gives 2 to 3
minutes working time
 3.2mm for 1 minute at 70°C-75°C gives 4 to 6
minutes working time
 Chemical name: polyform: Minimum
resistance to stretch, Natural drape with
minimum handling. Ideal splinting material for
dynamic outrigger bases, lightweight paediaric
splints; thumb, finger, wrist and hand based

20.  High temperature thermoplastic: High-temperature
(polypropylene) thermoplastics require higher
temperature (100°C) to mold, but they are ideal for
high stress activities.
Adv- slightly elastic when heated.
has high impact of strength.
Disadv- can not drape directly on pt
does not fit in contour area
Temperature- 93-107 degree
Note:
Selection: based on diagnosis, preference, and
availability, cost.
Note: one kind of thermoplastic is not the best choice
for every type or size of splint.

21. PROPERTY
 Memory- ability to return its preheated shape
and size when its heated
 Drapability or Conformability- degree to ease a
heated material conforms or able to mold well
and produce an intimate fit.
 plasticity:- its materials resistance to stretch and
ability to return its original shape and size after
stretch.
 Bonding- ability of a material to adhere self
 Other like flexibility, durability, rigidilty.
 Perforation- density range 1-42%.
 Size- 1.6(1/16), 2.4(3/32), 3.2(1/8), 4.2(3/16) mm

22. TOOLS USED
 scissor
 heat gun
 Hot bath( splint pan)
 Hole punch
 Plier
 Hand drill
 Others : paper, pencil or marker,
stockinette, towel and liquid hand soap.

23. ANATOMICAL AND
BIOMECHANICAL
CONSIDERATION FOR SPLINTING
1. Crease
2. Arches
3. Bony prominence
4. Sensibility
5. Muscle action
6. Nerve
7. Vessels

24. BIOMECHANICAL
 The fitting and fabrication of splint require
accurate application of external forces to
the upper extremity.
 Increase area of force application
 Mechanical advantage
 Use of optimal rotational force
 Control reaction effects of secondary joint
 Shearing and friction force

25. PRINCIPLES OF SPLINTING
1. Design
2. Construction
3. Fit
4. Mechanical

26. DESIGN
PRINCIPLES
1. Most important consideration in the splint
design is that exact function expected for
specific patient.
 integration of the principles of fit, mechanics,
construction.
1. General principles: based on individual's
characteristics
 Consider individual patients factors, length of
time the splint will be used, simplicity and
cosmetic appearance, allowing optimal
function, ease of application and removal,

27. 2. Specific principles: pathological situation
which allow the therapist to create a splint
to ensure optimal functional benefits for
the patients.
 Based on specific personal, and medical
consideration, primary joint should be
identified, purpose of splint should be
reviewed like restriction, immobilization.
Self help device, area of loss or less
sensation, anatomical variation,

28. CONSTRUCTION
PRINCIPLES
 It is related to selecting equipment, method to
the materials used will help to ensure the
durability, cosmesis, comfort, and usefulness,
 splint corner should be rounded, edge
smoothed, joint surface should be stabilized,
strap and pad should be secured, well finished,
ventilation may be provided if it is necessary.
Construction splint divided into 5-phase;
 1.transfer of pattern to material, 2. heating of
the materials, 3. cutting the materials, 4. joining
the separate part and 5. finishing

29. FOR IN SPLINTING
 Biomechanical: using biomechanical of kinetics
and force acting on body.
 Sensorimotor: in case of CNS damage to facilitate
or inhibit normal motor response.
 Rehabilitative: focuses on abilities rather than
disabilities.
 Its depends on the purpose.
1.To immobilize the joint (Biomechanical),
2. To assist in writing ability in patient with
muscle imbalance of Palmar prehension
(rehabilitative)

30. CONSIDERATION FOR CHILD AND
ADULTS
 1/16 inch thickness good for children
 Maintaining splint position is a common problem
 For stability purpose need to include extra joint
 Difficult to follow the principles of design and
construction
 Stockinette should be during fabrication of splint
 Colorful strap can be used
 Child’s skin is more sensitive than adult
 Child experience process of maturation and
neurological development

32. INTRODUCTION: HAND AND WRIST
 Series of complex, delicately balanced
joints
 Function is integral to every act of daily
living
 Most active portion of the upper extremity

33. •Phalanges: 14
•Metacarpals: 5
•Carpals
Proximal row: 4
Distal row: 4
•Radius and Ulna

35.  Muscles /Tendons
 Volar and dorsal wrist
 Volar and dorsal hand
 dorsal interossei
 Palmar interossei
 Nerves - 3
 Median
 Ulnar
 Radial
 Arteries - 2

36. CLINICAL EXAMINATION
 Age
 Handedness
 What exacerbates
 What improves
 Duration
 Chief complaint
 Occupation
 Previous injury
 Previous surgery

37. EXAMINATIONS
 Inspection
 Palpation
 Surgical scar
 skin
 Muscle power
 Range of Motion
 Neurologic Exam
 D/T/R
 Hand posture
 Sensation
 Vascular status
 Wound
 nerve
 Cognition and perceptual abilities

38. FEATURES AND PURPOSE OF SPLINT
 Resting hand splint: a resting hand splint is
a static splint that immobilize the fingers,
thumb, and wrist.
 Indication:
 Functional position
 Inflammation
 Burn
 Crush injury
 Features; F/A trough, pan, thumb trough,
and C bar.
- Support the hand, 2/3rd of F/A, thumb 40-45
palmar abduction, fingers position can vary
a/c to purpose of the splint.

39. PROPER FITTING
 More than 1 inch in each side
 Material that has enough strength and rigidity
 Make sure splint supports hand
 Position should be as per purpose, should not
be more than 5 degree ulnar deviation
 Strap proximal to PIP and across the proximal
and distal F/A
 Arches and contour should be maintained
 C bar works as per indication
 Thumb trough should be long enough

40. PRECAUTIONS
 Pressure area
 Prevent infection (clean and dry properly if
open wound exist)
 In ICU therapist should follow up at least
once regarding fit

41. THUMB SPICA SPLINTS
 Also called thumb immobilization splint
 Purpose: immobilize, protect, rest.
 Indication: scaphoid fracture, radial or uknar
collateral ligaments strain, median nerve injury,
quervain’s tenosynovitis.
Features:
Static, wrist can be included or can not, thumb
post, c bar and opponens bar, position of thumb
can vary from palmar abduction to radial
abduction

42. PROPER FIT AND PRECAUTION
 Monitor joint position by measuring during and
after fabrication
 Allows IP movement
 Precaution:
 Do not disturb IP joint flexion
 It should be supportive not the constrictive
 Make sure thumb position is around 45 degree
palmar abduction

44. COSTING
 Direct costing
 Material cost(per inch, or per square inch)
 Therapist time(in fitting, fabrication, and
explanation of the splint)
 Strap materials
 Padding materials
 Fasteners
 Stockinet
 Revets
 Cooling spray
 Indirect costing:
 Nondisposable supplies( scissors, time, rent,
electricity,

45. CHECKOU
T
 General consideration
 Is the splint on the patient correctly fit
 Does the splint needlessly immobilize a joint
 Does this splint actually accomplish the
function for which it was made
 After 30 minutes, whether the patients get
redness and do this disappear within 15-20
mins
 Is the splint cosmetically acceptable for the
patients
 any pressure point
 Are the edges, insides etc. padded or

46. CHECKOUT FOR PROPER
FIT
 Pressure point and friction should checked
 Check for comfort ability and safety
 Longitudinal and transverse arch should be
maintained
 Obliquity of MP should be maintained
 Fingers should be in the appropriate position to
maintain function.
 Thumb should be in the functional position
 Wrist should be neutral or 15-30 degree extended
 Splint should not restrict the motion of any
uninvolved joint
 Fingers and thumb piece should be long enough to
give adequate support

47. PRECAUTI
ON
 Splint is a foreign body use to apply to the
living tissue
 Client must taught to monitor the status of
their splinted extremities
 Presence of pain, reddened areas,
blisters, swelling, rashes, or the problem
associated with splint must be reported to
the therapist
 Do not expose to the warm and hot water
or any hot materials

48. DOCUMENTATIO
N
 Clients name
 Ip or op number
 Age
 Sex
 Hand dominance
 Date
 Diagnosis
 Reason for referral

49. Baseline measurement:ROM,strength,sensitivity,
dexterity,
 Date of measurement
 Measurement
 Date of delivered
 Material used
 Cost of splint
 Nomenclature of the splint
 Types of splint
 Follow up