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 Nurul Asyuraa

 Azrir Marx Aideit

 Nor Maizan

SN Ayishah

Diploma holder in Occupational Therapy

Currently studying for Bachelor in Occupational Therapy(hons)

Faculty of Health Sciences

University Technology of Mara(UiTM)

Puncak Alam

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How to make a Splint

Material used:

Elastic Bandage

 Cutter Blade

 

 Heat Gun

 Heat Pan

 Heavy Duty Scissor

 Instant Cooler

 

Stockinette

 Thermoplastic

Valcro Set

Procedure:

1. Prepare the patient
1. Cover patient with sheet or gown to protect clothing
2. Inspect skin for wounds and soft tissue injuries
3. Clean, repair and dress wounds as usual prior to splint application
2. Padding
1. Apply stockinette to extremity to extend several cm beyond edges of plaster, so that it may be folded back over the edges of the splint after plaster is applied to create a smooth edge
2. Roll on two to three layers of cast padding evenly and smoothly (but not too tight) over the area to be splinted.
3. Extend the padding out beyond the planned area to be splinted so that it can be folded back with the stockinette over the edges of plaster to create smooth edges.
4. Each turn of the webril/cast padding should overlap the previous by 25-50 % of its width.
5. Place extra padding over bony prominences to decrease chance of creating pressure sores
6. An alternative to circumferential stockinette and cast padding is to place 2-3 layers of padding directly over wet plaster, and then apply this webril-lined splint over the area to be immobilized and secure it with an elastic bandage
3. Prepare the plaster splint material
1. Ideal length and width of plaster depends on body part to be immobilized in the splint
2. Estimate the length by laying the dry splint next to the area to be splinted
3. Be generous in estimating length, the ends can always be trimmed or folded back
4. Width should be slightly greater  than the diameter of the limb to be immobilized
5. Cut or tear the splint material to the desired length
6. Choose thickness based on body part to be immobilized, patient body habitus, and desired strength of splint

             i.      Average of 8-12 layers

             ii.      Less layers (8-10) for upper extremities

             iii.      More layers (12-15) for lower extremities

             iv.      More layers may be needed for large patients

7. Fill a bucket with cool water, deep enough to immerse the splint material into

             i.      Using cool water decreases the chances of thermal burns, but takes longer for the splint to dry

4. Application of the splint
1. Submerge the dry splint material in the bucket of water until bubbling stops
2. Remove splint material  and gently squeeze out the excess water until plaster is wet and sloppy
3. Smooth out the splint to remove any wrinkles and laminate all layers
4. Place the splint over the webril cast padding and smooth it onto the extremity
5. An assistant (or a cooperative and willing patient) may be required to hold the splint in place while you adjust the splint
6. Fold back the edges of the stockinette and cast padding over the ends of the splint
7. Secure the splint with an elastic bandage
8. Place the extremity in the desired position and mold the splint to the contour of the extremity using the palms of your hand.  (Avoid using your fingers to mold in order to decrease indentations in the plaster which can lead to pressure sores)
9. Hold the splint in the desired position until it hardens
5. Check and finish the splint
1. Check for vascular compromise
2. Check for discomfort or pressure points
3. Apply tape along the sides of the splint to prevent elastic bandages from rolling or slipping, (avoid circumferential tape to allow for swelling)
4. Provide sling or crutches as needed

PURPOSE & CHARACTERITIC

Purpose & use:

• By the emergency medical services or by volunteer first responders, to immobilize a fractured limb before the transportation; it is then a temporary immobilization;
• By allied health professionals such as occupational therapists, physiotherapists and orthotists, to immobilize an articulation (e.g. the knee) that can be freed while not standing (e.g. during sleep).
• By athletic trainers to immobilize an injured bone or joint to facilitate safer transportation of the injured person.
• By emergency room physicians to stabilize fractures or sprains until follow-up appointment with an Orthopedist.

Characteristics of splint

Handling characteristics

1.      Memory

·   The material’s ability to return to its preheated (original) shape, size, and thickness when reheated.

·   Easier to monitor and determine whether the material is properly contoured onto the surface of the skin.

    Allows therapist to reheat and reshape splints several times without the material stretching excessively.

 

2.      Drapability

·   Degree of ease with which material conforms to the underlying shape without manual assistance. 

3.      Elasticity

·   Material’s resistance to stretch and its tendency to return to its original shape after stretch.

4.      Bonding

·   Self –bonding or self-adherence is the degree to which material will stick to itself when properly heated.

5.      Self-finishing edge

·   That allows any cut edge to have a smooth texture if the material is cut when warm.

Performance characteristic

6.      Conformability

·   Ability of thermoplastic material to fit intimately into contoured areas. Easily drape and has a high degree of conformability can pick up persons’ fingertips and crease marks.

7.      Flexibility

·   A thermoplastic material with a high degree of flexibility can take stresses repeatedly. Flexibility is an important characteristic for circumferential splints because these splints must be pulled open for application and removal.

8.      Durability

·   The length of time splint material will last. Rubber-based materials are more likely to become brittle with age.

9.      Rigidity

·   Materials that have a high degree of rigidity are strong and resistant to repeated stress. Rigidity is especially important when therapists make medium to large splints (such as splint for elbows or forearm).

·   Large splints require rigid material to support the weight at larger joint. In smaller splints, rigidity is important if the plastic must stabilize a joint.

1      Perforations

·   Allow for air exchange to the underlying skin. Various perforation patterns are available.

·   Perforated and superperforated materials allow air exchange to the underlying skin surface and reduce the weight of splint.

1    Finish, colors, and thickness

·   Finish refers to texture of the end product.

·   Colored splints tend to show less soiling and appear cleaner. Brightly color splints tend to be popular with children. Colored materials may be used to help a person with unilateral neglect call attention to one side of the body.

·   One common thickness for thermoplastic material is 1/8 inch. However, if the weight of the entire splint is concern, a thinner plastic may be used, reducing the bulkiness of the splint and possibly increasing the person’s comfort and improving compliance with the wearing schedule. 

Variety of Splint

Resting Hand Splint  

Provide rest to soft tissue structures, joint or several joints.
Occupational therapist use this splint to immobilize with such diagnose as rheumatoid arthritis, carpal tunnel syndrome, fractures and soft tissue repairs. 
Also provide support for joint laxity and ligament injury.

Ulnar Deviation Splint

Prevent further deformity by maintaining stretch on soft tissue to increase range of motion (ROM) and help align and stabilize joints.
Occupational therapist commonly use this splint to help prevent further ulnar deviation deformity for person who have rheumatoid arthritis

 

Tenodesis Splint

Ideal splint for C6 quadriplegic patients or anyone with wrist extension strength but no finger strength.  

Use as a training device prior to fitting permanent tenodesis orthosis. 

Splint stabilizes thumb and holds index and long fingers slightly flexed. When the wrist is extended, the static line attached to the wrist cuff pulls the finger MP joints into flexion, creating a fingertip pinch ability and gross grasp ability.   

Change size of gross grasp using the adjustable cord lock. Fits left or right hand. To size, measure width at the MP joint

Proximal Interphalangeal (Pip) Joint Flexion Mobilization Splint

Designed for use by individuals with hand disabilities. 
Useful when one or two digits are involved, this kit provides small, pre-bent outriggers that can be placed over the metacarpals or on the fingers. 
Each outrigger holds one rod adjuster/extender rod unit for precise positioning of the MCP, DIP, or PIP joints. 

Dorsal Blocking Splint 

Designed to immobilize the wrist, MCP's and IP joints leaving the thumb free for function. 
Sometimes called a back slab splint and is used clinically following flexor tendon repairs. 
The palmar bar provides maximum support and reduces splint migration.

Anti-Spasticity Ball Splint 

Designed as an anti-spasticity splint with a corrugated finger design, this splint is fabricated using a ball.
It can be made with either a dorsal or volar arm piece. 
Anti-spasticity ball splints position the wrist, abduct the fingers and thumb, and maintain the palmar arch in a reflex-inhibiting position

 

Thumb spica Splint

The thumb spica splint prevents the thumb from moving and pushing against the palm.  
Occupational therapist often uses this type of splint with patients suffering from a broken thumb.