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ORTHO

Part 1

TermDefinition
splints in middle ages Triangular parts of armor that allows movement but gives protection Material include wood, steel straps, iron, aluminum
first thermoplastics High temp, requires 160-180C to soften Durability Lengthy time to complete since need casting (skin can't handle it) Polyethylene & polypropylene
first low temp thermoplastics Prenyl, sansplint, polyform, orfit, aquaplast Allow molding directly on client (<100C) Over 50 we can choose today
orthosis Changed name in 1998 Externally applied device used to modify structural & functional characteristics of NM & skeletal systems by applying forces to body
optimum orthosis fabrication needs Knowledge of anatomy, wound physiology, mechanical principles & design, splinting materials, client needs Skills Creativity
immobilization/ static splint purposes Protect healing structures Control symptoms (decrease pain/ edema) Prevent deformity/ enhance function (decrease contracture & tone)
intrinsic plus For someone with metacarpal # where they have swelling Stretching the collateral ligaments
mobilization splint purposes Maintain/ increase range of movement Includes serial static/ dynamic/ static progressive splints
1. serial static splint 2. dynamic splint 3. static progressive splint 1. Progressive fixing of the joint 2. Elastic makes movement possible. Gentle pull. Enhances movement.. 3. Held in position of max range. Client can adjust themselves
radial nerve injury Dynamic splint used to assist active movements Wrist is supported in extension Coils can be resisted, but they pull fingers back into extension
blocking splint purpose To direct movement Block movement in one joint to allow movement in another joint Fix any compensation
thermoplastics & temperature Fluid at room temp, but very viscous Heating decreases viscosity so fluid becomes more fluid
plastic vs. rubber group characteristics Polycaprolactone/ polyester base plus fillers are more conforming & have memory vs. Ployisoprene base are less conforming & have little/ no memory. But stronger
life span of orthosis Unlimited ability to remold, but limits aging Gradual deterioration due to oils, UV rays, bacteria Positive aspect of aging (biodegradability)
design & shaping of splints 3 point pressure system (middle force opposite to proximal & distal forces) Control or bring about joint movement Use optimum length & width (2/3 length of forearm, through halfway up sides)
comfort & shear reduction Spread force out over large area Pad boney prominence before molding Round splint edges & flare proximal weight-bearing edge Don't incorporate more joints than necessary
strapping Apply securely Ensure location of straps controls joint movement Ensure adequate width so force is distributed over large area Angle of pull should be at 90deg to segment that is mobilized
client considerations for designing Cosmesis- avoid penmarks, rough edges, surface impressions Ensure orthosis is easy to apply & remove Keep it simple Consider properties of material you are using
splinting material properties Stretch/ conformability Rigidity Adhesiveness Perforations Thickness
general client assessment Address their concerns Lifestyle- when can they wear it? Limits? Proximity to clinic Cognition- Ability to follow instructions Physical limitations- donning/ doffing? Vision? Motivation, wound factors, sensation screening
If client has poor AROM but good PROM We wouldn't splint because it is AROM Give exercises instead Splint to maintain PROM (at night)
skin tightness Apply stretch, observe blanching or tightness of scar line/ skin graft Skin in shortest position, increase joint motion proximally or distally Static orthosis that keeps skin at max length, pressure to scar Include prox & distal jnts
joint tightness Measure PROM then eval if range changes when position of prox/ distal jnts changed. No change= isolated tightness Orthosis goes prox to distal
tendon adherence & muscle tendon tightness Difference in distal jnt motion when proximal jnts positioned in flex or ext Present anywhere along injured unit Difference in tightness seen distal to adhered pnt
extrinsic extensor issues Fingers unable to flex as far with wrist in flexion as with wrist in extension Splint digits and wrist in flexion. May give them exercises instead since median nerve tingle
extrinsic flexor issues Finger unable to extend as far with wrist in extension as with wrist in flexion Splint wrist and fingers in extension, moreso in serial static position
intrinsics issues IP flexion less when MCP is extended than when its flexed Splint MCP extended, IP flexed Active hook exercises to decrease tightness
extrinsic extensor issues + swelling Swollen hand means something is going to be tight Digisleeves to decrease swelling Splint all joints of hand in flexion
crush injury Resting splint in intrinsic plus position- support & help prevent stiffness
stiff thumb joint splint Dynamic splint thumb flexion splint
pronation/ supination splint 2 piece splint that uses one strap to gain pronation/ supination, depending on direction of pull Uses gravity as mobilizing force Elbow immobilized to prevent compensation Considered a serial static splint
dupuytrens contracture Abnormal thickening of palmar fascia which over time can cause fingers to contract into palm Most likely in D4 and 5 Extension splint created after release surgery
mallet finger Ext tendon lesion DIP in full extension- slight HE for at least 8 weeks First 3-4 weeks are critical Tendon ends meet each other via scar tissue
trigger finger Inflammation & narrowing of A1 pulley Resting night splint, other devices Trigger finger splint to keep MCP in ext & active hook fist exercises & no active MCP flexion/ gripping 6 weeks at least
client education on Donning/ doffing Wearing schedule Care of splint Precautions Contact information Follow-up
Created by: craftycats_
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