Dynamic Splinting Research Articles

A dynamic nostril splint in the surgery of the nasal tip: technical innovation

Some types of surgery performed on the tip of the nose, such as secondary rhinoplasty on cleft lip and palate (CLP) patients, may have an uncertain end-result due to the difficulty in maintaining the surgically created status constant over time. This is precisely the reason behind the multiple proposals and surgical techniques presented by various authors through the years, in order to produce a long lasting, valid, surgical result. The problem has been approached by implementing varied and creative methods and still remains partially unsolved. Experience has shown that the application of a dynamic nasal splint has contributed efficiently to maintaining the surgical results by opposing healing contraction.

EARLY MOTION AFTER ARTHROPLASTY

Early controlled motion after arthroplasty in the MP and PIP joints allows for collagen remodeling during the encapsulation process that creates a stable joint. Motion generally is begun within the first few days after surgery and must be supervised carefully. Dynamic splinting is an important component in achieving early motion in the MP joints and often is a useful adjunct in the PIP joints. Early motion after total wrist arthroplasty depends on surgical fit of the prosthesis. Only a tight fit allows early motion. The potential for complications resulting from early motion in the wrist is greater than in the MP or PIP joints and may involve increased wear, fracture, or component loosening. The benefits of early motion after arthroplasty, therefore, must be weighed against potential risks. Although generally necessary in the MP and PIP joints to achieve satisfactory results, early motion after total wrist arthroplasty has limited applications and significant risks.

A Study of a Dynamic Proximal Stability Splint in the Management of Children with Cerebral Palsy

A Study of a Dynamic Proximal Stability Splint in the Management of Children with Cerebral Palsy

Versatility of the homodigital triangular neurovascular island flap in fingertip reconstruction

This paper reports 25 cases of a versatile homodigital triangular neurovascular island flap for fingertip reconstruction. This flap was used to reconstruct traumatic oblique palmar amputations, with loss of fingertip pulp requiring advancement of not more than 2 cm. Good results were obtained in terms of fingertip contour and padding, sensibility, and functional recovery. The tendency for flexion contracture at the PIP joint was prevented by using a dynamic extension splint at night. Cold intolerance must be expected, especially in cold countries.

Anatomy of the proximal interphalangeal joint and splintage of flexion contracture

Flexion contracture of the proximal interphalangeal joint may be treated by either static or dynamic splintage. This article reviews the merits of each type of treatment.

Functional results of dynamic splinting after transmetacarpal, wrist, and distal forearm replantation

The results of replantation at the wrist and distal forearm are reported to be better than at the metacarpal level, in part because the latter involve direct injury to the intrinsic muscles. This study evaluates a new post-operative protocol for replantation at the metacarpal, wrist and distal forearm levels. 3 days after replantation, the patient was placed in a dynamic crane outrigger splint with MP joint control, compensating for intrinsic muscle function loss. From 4 to 12 weeks, an anticlaw splint alternated with the outrigger splint. After 12 weeks, a dynamic wrist extension orthosis was added to the anti-claw splint. 11 patients (four replantations at the transmetacarpal level, three at the wrist and four in the distal forearm) had this protocol between 1988 and 1993. For distal forearm replantation, TAM of fingers averaged 216 degrees, grip strength 42 lb, and pinch strength 7.2 lb with 75% good or excellent results. For wrist replantations, TAM of fingers averaged 243 degrees, grip strength 37 lb and pinch strength 10.6 lb with 100% good or excellent results. For transmetacarpal replantations, TAM of fingers averaged 189 degrees, grip strength 37 lb and pinch strength 5.6 lb, with 75% good and excellent results. Early protected mobilization, as described here, preserves tendon gliding, muscle strength and excursion. Our results support this protocol for wrist and distal forearm replantation and especially for transmetacarpal replantation, the results of which tend to be poor according to the medical literature.

Active Traction Splinting for Proximal Interphalangeal Joint Injuries

Proximal interphalangeal joint injuries can severely affect hand function. Early, active motion is important in ensuring a good range of motion and a functional outcome. Active traction splinting is a dynamic splinting system that can be performed with either open or closed reduction of phalangeal joint fractures, especially at the proximal interphalangeal level. This system allows for continued traction on the involved joint and thereby aids in providing a dynamic force that will unload the joint throughout its arc of motion and noticeably decrease pain. Early, active therapy and the continual in-line traction enables the patient to achieve an almost full range of motion early in the course of rehabilitation. This combination contributes significantly to improve patient understanding and compliance. The benefits of the active traction system are reduction of fragments, marked decrease in pain, and early range of motion with improved patient compliance. Early, active motion facilitates improved joint nutrition, contouring, and healing. Active traction splinting for proximal interphalangeal joint injuries is a relatively simple and effective method for treating these complex injuries.

The treatment of chronic flexion contractures of the proximal interphalangeal joint

A method of treatment of chronic flexion contractures of the PIP joint is presented, with the results obtained in 19 patients treated between 1989 and 1992 after a follow-up of from 6 to 53 months. The flexion contractures, with an extension deficit which ranged between 70 and 90 degrees, had been present for a period of between 2 months and 24 years. Our treatment program involves the surgical release of the unreducible PIP joint followed by the use of static and/or dynamic splints. Surgery is performed using a midlateral approach; the accessory collateral ligament and the flexor sheath are incised and, after the volar plate and check-rein ligaments have been excised, forced hyperextension is applied. The main collateral ligaments are carefully spared and freed from the condyle if there are any remaining adhesions. In our 19 patients, complete extension of the finger was achieved in 11 cases (57.9%); in the remaining 8 cases (42.1%) the residual extension deficit ranges from 10 to 15 degrees. In our experience this combined surgical and rehabilitative approach had led to consistently good results with minimal complications.

Traitement chirurgical des camptodactylies

Almost all anatomical structures of the hand have been held responsible for non-traumatic, non-paralytic flexion deformity of the proximal interphalangeal joint. Together with Millesi and Flatt, we define camptodactyly as a disorder of flexor-extensor equilibrium in the PIP. This definition determined our therapeutic approach. 59 patients with one or several fingers affected by camptodactyly were followed between 1975 and 1989. In 3 cases, the anomaly was associated with another malformation of the hand and 56 cases, it was isolated. 11 children did not receive any active treatment, but were followed and manipulated. 17 (27 fingers) were treated by static or dynamic splints. 31 (43 fingers) were operated according to the following technique: total anterior tenoarthrolysis leading to recession of the flexor apparatus and lengthening of the skin on the palmar surface of the first phalanx by a rotation flap. This operation was preceded and followed by application of a dynamic extension splint onto the operated finger. Of the 20 fingers treated by manipulations and reviewed, 11 had improved, 7 were stable and 2 had deteriorated. Of the 24 fingers treated by splints and reviewed, 14 had improved, 5 were stable and 5 had deteriorated. Of the 30 fingers operated and reviewed, 30 had improved, 7 were stable and 2 had deteriorated. Although recent anatomical studies tend to indicate that anomalies of the lumbrical muscles are frequent in operated camptodactyly, these studies do not take into account the numerous anomalies of these muscles observed in the general population. The therapeutic conclusion resulting from these studies are also unconvincing. The technique which we propose cannot be applied to every case. The milder forms only require orthopaedic treatment. C camptodactyly in adolescents or adults with joint blocking are only slightly improved by surgery and only require corrective osteotomy. In all other cases, especially in young children, anterior tenoarthrolysis of the finger with cutaneous elongation allows reduction or correction of the deformity.

Low-Profile Dynamic Wrist Splint

A low-profile dynamic wrist splint has been designed for use by patients who have undergone simultaneous de Quervain's release and basal joint arthroplasty. The splint allows gentle postoperative gliding of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons while stabilizing the basal joint arthroplasty. Excursion of APL and EPB tendons over the basal joint area is vital to prevent adherence of the tendons or the superficial radial sensory nerve in this area. The splint is for daytime use only. A forearmbased thumb spica splint should be used at night and during high-risk activities . The splint may be placed as early as 24 hours postoperatively .

Early Controlled Motion with Dynamic Splinting versus Static Splinting for Zones III and IV Extensor Tendon Lacerations: A Preliminary Report

Recent developments in the understanding of tendon healing and the effects of early motion have led to early controlled motion programs (ECM) for lacerated extensor tendons. The purpose of this study was to determine whether there were differences in length of treatment and final results when patients who had been treated with ECM with dynamic splinting were compared with patients who had been treated with traditional static extension splinting (SES) for zone III and zone IV extensor tendon lacerations. A retrospective study of patient charts from June 1984 through January 1990 was conducted. A total of 36 charts were reviewed. Twenty-seven patients met the study criteria: treatment with ECM with dynamic splinting (n = 10) and treatment with traditional SES using a finger-hand splint (n = 17). Data were analyzed for total number of therapy visits (V), total number of weeks of therapy before discharge (W), total active motion achieved (TAM), total passive motion achieved (TPM), and incidence of complications. Significance was established at the p = 0.05 level for all statistical analyses. There were no significant differences between the groups for V (t =1.76, p = 0.09), W (t = 0.58, p = 0.57), TPM (t = 0.12, p = 0.90), TAM (t = 0.44, p = 0.66), or the incidence of extensor lag (X2 = 2.264). The Cohen stat power analysis value was 0.40, revealing that the number of patients was too small for significance. The earlier return to work in the ECM group did not result in a greater extensor lag or a difference in TPM or TAM. The differences in V and W, although not statistically significant, may represent a way to control the cost of care. A larger sample is needed to determine whether ECM with dynamic splinting is indeed successful in significantly reducing rehabilitation time without sacrificing proximal interphalangeal (PIP) joint extension, TAM, or TPM.

Comparison of the Biomechanical Motions and Forces Involved in High-profile versus Low-profile Dynamic Splinting

The purpose of this study was to compare the biomechanical motions and forces generated with a commercially available high-profile splint with those generated with a commercially available low-profile splint outrigger. The efficiency of the splints for maintaining index-digit supination during active flexion with the digit placed in slings generating a supination force couple was analyzed. The forces necessary to initiate and to maintain finger flexion were studied for each device using force transducers. Motion and force analyses were performed in the Biomechanics Evaluation Laboratory at Michigan State University. Synchronized video cameras recorded movement of anatomic landmarks, which were located by way of spherical retroreflective targets. Software programs calculated joint angles and digit movement. The results indicated that the high-profile splint held the digit in greater supination during flexion than did the low-profile splint. Also, the high-profile splint required less force during active flexion to initiate and to maintain motion than did the lowprofile splint.

Static Progressive Stretch to Reestablish Elbow Range of Motion

Static progressive stretch (SPS) is a technique using the biomechanical principle of stress relaxation to restore range of motion (ROM) in joint contractures. Existing techniques such as dynamic splinting and traction rely on a time-dependent material property, creep, which applies a continuous load. Other techniques, such as serial casting and static splinting, are time intensive and usually require assistance by a therapist. This study evaluates SPS via a new orthosis that directly applies SPS incrementally through patient-controlled therapy, allowing for stress relaxation of contracted tissue. Patients used the device in 30-minute treatment protocols. The length of treatment time varied between one and three months. Twenty patients with elbow contractures who had limited success with other treatment modalities including serial casting, dynamic splinting, physical therapy, and/or surgery, underwent SPS using the new orthosis. The increase in motion for the 20 patients in the study averaged 31 degrees (69%). All patients expressed satisfaction, with no complications and no deterioration in ROM at the one-year follow-up evaluation.

Dynamic pronation splint in high level spinal cord injury: A case study

Maintaining pronation of the forearm is difficult for patients with high level quadriplegia. Where partial innervation to, or weakness within, specific muscles of the upper limb occurs, the arm tends to be held in a flexed, supinated position. This position prevents the successful performance of many activities of daily living. The dynamic splint outlined in this paper is based on the Roylan Dynamic Pronation/Supination Kit with adaptions to enable elbow flexion. The application of this splint in a patient with incomplete quadriplegia below C5 cord segment has been described. This splint was introduced during the rehabilitation phase of treatment, and enabled the forearm to be positioned in pronation, so that the patient could perform functional activities such as feeding, typing, writing and using the telephone. Following discharge from hospital, the patient used the splint to help achieve goals such as returning to work and playing the piano.

THE THERAPIST'S MANAGEMENT OF INTRA-ARTICULAR FRACTURES

Fabrication of the dynamic traction splint is described in step-by-step fashion in order to aid surgeons to understand the principles of application of the method and to assist hand therapists to make the splint. The new 6-inch diameter arcuate hoop and the radial or ulnar gutter base splint are detailed. Modification of continuous passive motion machines is described for use in conjunction with dynamic traction. Alternative splint applications and post-dynamic traction splinting therapy methods are outlined.

Camptodactylie : classification et résultats thérapeutiques. A propos d'une série de 50 cas

Fifty patients with camptodactyly of one or several fingers were seen in the Strasbourg SOS Main unit between 1980 and 1988. Classification of these lesions was based on the mobile or fixed nature of the deformity in flexion of the interphalangeal joint. This classification is useful for the therapeutic management. Treatment by dynamic splint for a mean duration of 20 months gives good results in fixed or mobile camptodactylies of small children, provided that this treatment is commenced as soon possible. This splint treatment also obtains favorable results in patients reaching the end of the growth period, whether their camptodactyly is mobile or even, in some cases, fixed. In every case, treatment by dynamic splint constitutes a therapeutic test (safety of the apparatus, patient's cooperation) and only forms of camptodactyly resistant to conservative treatments benefit from Malek's type of surgical correction. It must be remembered that a certain number of cases of camptodactyly have a potential for severity with time, progressing towards irreducible forms which can only be corrected by surgical treatment. Camptodactyly in adults must be analysed meticulously and only major deformities causing functional discomfort or major aesthetic prejudice should be operated.

Effect of dynamic splint for elbow joint contracture.

Effect of dynamic splint for elbow joint contracture.

Low-profile Dynamic Splints: A Solution to the Friction Problem

To find a solution to the problem of friction between the nylon fishing line and the outrigger of a low-profile dynamic splint, a jig was manufactured to bend notches in 2.5-mm coppercoated welding rod. This type of outrigger was compared with an adjustable stainless-steel outrigger to determine which of the two types produces the least amount of friction. As one of each type of outrigger was covered with a layer of Teflon paint, four different outriggers were compared with each other: welding rod only, welding rod with Teflon, stainless steel with Teflon, and stainless steel only. Equal traction units were attached to each of the outriggers and the amount of elongation of a 50-mm tension spring was measured when a 300-g weight was hooked onto it. This was compared with the elongation of the same spring when no friction was present. The results show that the Teflon-covered outriggers displayed significantly (on a 5% level) less friction than did the uncovered outriggers. The stainless-steel outrigger with Teflon performed slightly better than the welding-rod outrigger with Teflon. However, there was no significant difference between these two outriggers, and because the welding-rod outrigger is cheaper and more readily available, it is recommended for clinical use.

Mobilisation précoce protégée par appareillage de Levame après réparation primaire des tendons extenseurs de la main: A propos d'une série de 88 cas

Seventy patients with 88 lesions of the hand extensor apparatus were treated by primary repair followed by post-operative mobilisation with a dynamic steel blade splint (Levame). Results were good or very good in 97.7% of cases and moderate in 2.3% of cases for this series of simple lesions from zones 3 to 6. Prognostic factors influencing final result and wrist position during splint are discussed, the authors leave the wrist free for lesions in zone 3 and 4. Early mobilisation is the best treatment for tendinous lesions and a review of the literature confirms the validity of the author's choice. In spite of its biomechanical deficiencies, this simple technique may be used for non-disciplined patients and by non-specialized physiotherapists. For simple lesions of extensor tendons, the Levame splint may be considered as a real dynamic protective splint.

The Kleinert dynamic splint : where it fails and how it can be modified

After primary tenoraphy of flexor tendons one often finds a hampered function of the DIP-joint. Analysis of the pattern of early mobilization exercised by our patients in the Kleinert splint and analysis of the excursions of the flexor tendons of fresh unembalmed specimens brought us to the conclusion that the Kleinert dynamic splint fails in maintaining a sliding movement of the deep and the superficial flexor tendons along each other because the splint excludes motion at the distal interphalangeal joint. Based on our observations we modified the Kleinert dynamic splint. Our experience with 37 patients shows that this modified splint gives a better function in the DIP-joint.