Mallet Finger Treatment With Splint, Mallet injuries, whether bony or tendinous, should have closed treatment.[2, 3] This injured area is constrained tightly by adjacent unpadded skin dorsally, a tightly constrained hinge joint volarly, and the germinal matrix of the nail distally. Splinting of the distal interphalangeal joint (DIPJ) in full extension allows for healing of the injured structure and for restoration of excellent function and appearance, as shown belowPatient education and compliance are keys to good results.
Once extension splinting has been initiated, it should be maintained without even a momentary lapse for the prescribed treatment period. Tendinous injuries require 6-8 weeks of splinting, and bony injuries require 4-5 weeks. The time that is spent educating the patient regarding the necessity for nonstop protection in extension and techniques for maintaining joint extension (even when cleaning the finger and changing the splint) will be rewarded with favorable results.
The DIPJ should be immobilized in full extension so that the finger is straight. Sustained hyperextension of the DIPJ may cause ischemia to the skin over the dorsum of the joint and contribute to the development of pressure sores, as shown in the image below, which are occasionally observed as a result of tight splinting, especially in hyperextensionVarious means are available for holding the DIPJ in extension. Splinting can be isolated to the distal joint if the PIPJ is not lax and does not hyperextend. Splinting the proximal
interphalangeal joint (PIPJ) in partial flexion for the first half of treatment is appropriate if the untreated finger assumes a swan-neck posture. Small strips of aluminum with foam-rubber backing are commonly used. The foam backing should be of the closed-pore variety so that the foam does not absorb moisture. The open-pore form retains water in its interstices and harbors various microorganisms that hamper proper hygiene. Closed-pore foam aluminum strips are available from various orthopedic supply houses. The aluminum strip can be applied either dorsally or volarly.
Applied dorsally, the aluminum strip requires 2 strips of tape — one around the mid portion of the middle phalanx and one around the mid portion of the distal phalanx — for the splint to achieve 3-point fixation and maintain the distal joint in an extended position. Dorsal splinting allows the digital pulp to be partially exposed for keyboarding and other daily activities. In addition, dorsal splints are more effective at maintaining the joint in full extension. Volar splinting requires only one band of tape around the finger at the level of the distal joint to achieve 3-point fixation. As such, the volar splint and single strip of tape are slightly easier to apply and maintain, but the aluminum precludes any tactile feedback from the digital pulp for light activities. Other rigid materials can be used for makeshift splints.
A large paper clip can be padded with adhesive tape and then used as a splint. Also, some patients have improvised temporary splints with plastic disposable spoons or sections of wooden ice-cream sticks. Premolded plastic splints are available commercially; however, they often do not fit the finger sufficiently closely to maintain the joint in full extension. These splints have the added disadvantages of entirely covering and blinding the pulp from tactile sensation and preventing evaporation of moisture from the enclosed skin. Having witnessed the shortcomings of the various splints as noted above, the author devised a simple, custom-molded plastic splint, as shown below. This splint leaves the pulp relatively exposed for functional activities, adheres closely to the contour of the digit without the need for tape, and is of sufficiently low profile to allow for evaporation of moisture from between the splint and the skin. Blanks can be made from various thermoplastic materials that are routinely used by hand therapists or can be purchased commercially. The technique for applying this splint is demonstrated in a short video, below. (Contact George Tiemann & Co [25 Plant Ave, Hauppauge, NY, 11788; phone: 800-843-6266] to request more information or to purchase the Meals Custom Malleable Mallet Mender splint.)Regardless of the splinting method that is used, patients should have a follow-up appointment
1 week following the initiation of splinting to ensure that the joint is being properly maintained in extension and will continue as such. An adjustment in splint size may be necessary if any surrounding edema has subsided. At the end of treatment (4-5 wk for bony injuries and 6-8 wk for tendinous injuries), the DIPJ should be stiff in full extension. Full-time splinting in extension for an additional 2-4 weeks is advised if an extensor lag is noted. If no extension lag is present and strength against resistance can be demonstrated, the patient should begin a slow weaning of the splint over the next 1-2 weeks. At that point, the splint should be used for 2-4 more weeks at night and with activities that put the joint at risk. The patient may then resume full activity. Specific finger exercises to regain flexion are very rarely required.
Once extension splinting has been initiated, it should be maintained without even a momentary lapse for the prescribed treatment period. Tendinous injuries require 6-8 weeks of splinting, and bony injuries require 4-5 weeks. The time that is spent educating the patient regarding the necessity for nonstop protection in extension and techniques for maintaining joint extension (even when cleaning the finger and changing the splint) will be rewarded with favorable results.
The DIPJ should be immobilized in full extension so that the finger is straight. Sustained hyperextension of the DIPJ may cause ischemia to the skin over the dorsum of the joint and contribute to the development of pressure sores, as shown in the image below, which are occasionally observed as a result of tight splinting, especially in hyperextensionVarious means are available for holding the DIPJ in extension. Splinting can be isolated to the distal joint if the PIPJ is not lax and does not hyperextend. Splinting the proximal
interphalangeal joint (PIPJ) in partial flexion for the first half of treatment is appropriate if the untreated finger assumes a swan-neck posture. Small strips of aluminum with foam-rubber backing are commonly used. The foam backing should be of the closed-pore variety so that the foam does not absorb moisture. The open-pore form retains water in its interstices and harbors various microorganisms that hamper proper hygiene. Closed-pore foam aluminum strips are available from various orthopedic supply houses. The aluminum strip can be applied either dorsally or volarly.
Applied dorsally, the aluminum strip requires 2 strips of tape — one around the mid portion of the middle phalanx and one around the mid portion of the distal phalanx — for the splint to achieve 3-point fixation and maintain the distal joint in an extended position. Dorsal splinting allows the digital pulp to be partially exposed for keyboarding and other daily activities. In addition, dorsal splints are more effective at maintaining the joint in full extension. Volar splinting requires only one band of tape around the finger at the level of the distal joint to achieve 3-point fixation. As such, the volar splint and single strip of tape are slightly easier to apply and maintain, but the aluminum precludes any tactile feedback from the digital pulp for light activities. Other rigid materials can be used for makeshift splints.
A large paper clip can be padded with adhesive tape and then used as a splint. Also, some patients have improvised temporary splints with plastic disposable spoons or sections of wooden ice-cream sticks. Premolded plastic splints are available commercially; however, they often do not fit the finger sufficiently closely to maintain the joint in full extension. These splints have the added disadvantages of entirely covering and blinding the pulp from tactile sensation and preventing evaporation of moisture from the enclosed skin. Having witnessed the shortcomings of the various splints as noted above, the author devised a simple, custom-molded plastic splint, as shown below. This splint leaves the pulp relatively exposed for functional activities, adheres closely to the contour of the digit without the need for tape, and is of sufficiently low profile to allow for evaporation of moisture from between the splint and the skin. Blanks can be made from various thermoplastic materials that are routinely used by hand therapists or can be purchased commercially. The technique for applying this splint is demonstrated in a short video, below. (Contact George Tiemann & Co [25 Plant Ave, Hauppauge, NY, 11788; phone: 800-843-6266] to request more information or to purchase the Meals Custom Malleable Mallet Mender splint.)Regardless of the splinting method that is used, patients should have a follow-up appointment
1 week following the initiation of splinting to ensure that the joint is being properly maintained in extension and will continue as such. An adjustment in splint size may be necessary if any surrounding edema has subsided. At the end of treatment (4-5 wk for bony injuries and 6-8 wk for tendinous injuries), the DIPJ should be stiff in full extension. Full-time splinting in extension for an additional 2-4 weeks is advised if an extensor lag is noted. If no extension lag is present and strength against resistance can be demonstrated, the patient should begin a slow weaning of the splint over the next 1-2 weeks. At that point, the splint should be used for 2-4 more weeks at night and with activities that put the joint at risk. The patient may then resume full activity. Specific finger exercises to regain flexion are very rarely required.
Title: Mallet Finger Treatment With Splint
Rating: 100% based on 99998 ratings. 5 user reviews.
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Rating: 100% based on 99998 ratings. 5 user reviews.
Post by 3:07 AM
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