Fabricating a Volar Extension Splint for Colles' Fracture
Introduction[edit | edit source]
As described elsewhere, distal radius 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 fall from a standing height.[1]
Some distal radius fractures are managed conservatively, but many will require surgical fixation. We have provided detailed post operative protocols for Colles’ fractures fixed with open reduction internal fixation (ORIF) volar lock in plate screws here and here.
As noted here, patients will need a volar distal orthosis fitted day one post surgery. Here we outline a simple method of fabricating this splint. These splints are preferable to a circumferential splint as they are easier to take on and off.[2] As this patient group have had ORIFs to stabilise their fracture, there is no need for them to be fully immobilised.[3][4] The splints are primarily used for protection (ie in case of fall or a blow to wrist).[2]
Required Materials[edit | edit source]
- Thermoplastic sheet in basic rectangle template – length from patient’s MCP joints to around two thirds of the length of the patient’s forearm
- Frying pan
- Splinting sheers
- Egg flipper
- Looped Velcro straps x 3
- Sticky backed hooks x 3
Method[edit | edit source]
- Take thermoplastic sheet and place it into hot water in frying pan to make it soft and malleable. Please take care with the temperature before putting it onto the patient’s skin. Check it first!
- Once the thermoplastic sheet is very malleable, cut the thumb hole in. First piece the material with your scissors and cut a small circle out. Remember to make sure you check if the splint is for the left or right hand. As a general rule, the thumb hole should be around 3cm from the top of the sheet and 3cm in from the side.
- Place 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.
- Place splint on 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. 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 should be flat and thin, so that the thumb won’t get any pressure areas, when moving into abduction
- The thumb area should be large enough to ensure there is no rubbing on the CMC joint and to achieve full opposition between thumb and little finger
- Make sure the patient is in slight wrist extension when fitting the splint – usually 10-15 degrees
5. 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 length should be 2/3 of the forearm length and the sides should be trimmed so that the splint sits at around ¾ depth of the forearm.
6. Flare out the area around the ulnar styloid to avoid any pressure/rubbing in this area.
7. Place splint back into frying pan, so that you can roll the bottom and top edges to make it smooth on the edges for comfort.
8. Add velcro straps to splint, starting from the most distal strap (which should be the thinnest strap at 2cm wide). This strap should be positioned on a slight diagonal angle (ie place it on a downward tilt). For longevity of the splint, try using a heat gun to heat the backing of hook onto the splint.
9. Add middle strap (which should be 3cm wide) straight across the back of the wrist.
10. 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.
11. Place the splint on the patient’s arm. Remember to check:
- The distances at the MCP
- That the splint clears the CMC joint
- The wrist is slightly extended
- The straps should be firm, without being too tight
12. Trim straps down to fit the patient. Round the edges of the straps and Velcro hooks to stop them catching on clothing.
13. It is often useful to provide tubigrip or a splint sock to be worn under the splint to reduce rubbing/sweatiWhenng. This will help with comfort and may increase compliance around splint use
References[edit | edit source]
- ↑ 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
- ↑ 2.0 2.1 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.
