Fabricating a Volar Extension Splint for Colles’ Fracture

Introduction

Fractures of the distal radius (also called Colles’ fractures) are usually caused by a fall with the hand outstretched. [1] In children and young adults, the force required for this fracture is much greater (eg, a fall from a horizontal bar or a car accident), whereas in older adults, a fracture of the distal radius Often occurs after low-energy trauma (eg, fall from a standing height). [2][3] In the younger population, males are more likely to suffer this fracture. In the older population, it is more common in women. [4] Osteopenia in the elderly is also relevant. [5]

Many distal radius fractures are treated conservatively [6], but some require surgical fixation. You can read a detailed postoperative protocol for the fixation of a Colles fracture with Open Reduction and Internal Fixation (ORIF) here (0-6 weeks post-op) and here (6 weeks post-op).

Since improper management of distal radius fractures can lead to chronic wrist pain, reduce mobility, and affect hand function [7], appropriate treatment of these fractures is imperative. Although a recent review and meta-analysis of surgical management found no clinical significance Differences Between Various Surgical Options for One-Year Postoperative Functional Outcomes [8] The authors of the study state that:[8]

• Volar plating is associated with fewer complications, especially in individuals with intra-articular fractures
• Non-bridging external fixation associated with fewer complications in patients with extra-articular fractures
• Non-surgical treatment may still be preferred for those over 60

Patients treated with ORIF will require a volar distal orthosis on the first postoperative day. These splints are preferred over ring splints because they are easier to put on and take off. [9] Since this patient group was already using ORIF to stabilize their fractures, they did not need full Fixed. [10][11] Splints are primarily used for protection (i.e. in the event of a fall or a blow to the wrist). [9]

Here we outline an easy way to make this splint:

Required Materials

1. Thermoplastic sheet in a basic rectangular template – length is based on the distance from the patient’s MCP joint to approximately two-thirds of the length of his/her forearm
2. Frying pan
3. Splinting sheers
4. Egg flipper
5. Looped Velcro straps x 3
6. Sticky backed hooks x 3

Method

Figure 1. Thumb Hole Location on Thermoplastic Sheet

1. Remove the thermoplastic sheet and place it in the hot water in the skillet. This will make it soft and malleable. Check the temperature before placing the sheet on the patient’s skin to avoid burns.
2. Once the thermoplastic sheet has softened enough, cut the thumb holes. First use scissors to poke holes in the fabric and cut out a small circle. As a general rule, the thumbhole should be about 3cm from the top of the sheet and 3cm from the side of the sheet (see image 1).
3. Place the thermoplastic sheet back in warm water and crimp the edges of the thumbhole for a snug and smooth fit (see image 2).

   Figure 2. Rounded edges on volar splint

4. Place the splint on the patient’s hand. Thumbholes are hooked around their thumbs, and the plastic is molded around their forearms and across the flex of their hands. Ideally sit opposite the patient with their elbows on the table (see picture Remember to check:
   • The splint ends below the distal MCP crease so the patient can achieve full flexion of the fingers
   • The area between the thumb and forefinger is flat and thin so the thumb does not experience any pressure area when abducted
   • The area of the thumb is large enough to ensure no friction in the CMC joint, and to realize the complete opposition between the thumb and the little finger
   • The patient’s wrist is slightly extended when the splint is applied – usually 10-15 degrees

     Figure 3. Positioning of the Volar Splint on the Thumb

5. Once the plastic dries and hardens (which usually happens quickly), the splint can be trimmed to fit the patient. Remember that the splint should reach 2/3 of the length of the forearm, and the sides should be trimmed so that the splint is about ¾ of the depth of the forearm.
6. Spread the area around the ulnar styloid process to avoid any pressure/friction in the area.

   Figure 4. Position of the 3 Velcro straps on a volar splint

7. Place the strings back in pan so you can fold the bottom and top edges to loosen over the edges for comfort (see photo 2).
8. Insert a velcro strap into the splint starting from the farthest strap (which should be the thinnest strap with a width of 2cm). This strap should be placed at a slight diagonal angle (i.e. place it at a downward slope). If you want to extend the life of the cable, try using a heat gun to heat the back of the strap on it the binding of the medicine.
9. Add the middle strap (which should be 3cm wide) straight across the back of the sleeve.
10. The last loop lies at the near end of the loop. This strap should be placed at a slight angle so that it lies flat when the strap is inserted (see figure 4).

    Figure 5. Correctly placed volar splint

11. Place the strap on the patient’s arm. Remember to check:
    • The distances at the MCP
    • That the splint clears the CMC joint
    • That the wrist is slightly extended
    • If the wires are tight they are not too tight (see figure 5) .
12. Trim the bottom of the strap to fit the patient. Rope and Velcro around the edges of the straps to prevent clothes from getting caught.
13. It is often useful to provide a tubigrip or splint sock worn under the splint to reduce rubbing/sweating. This will help with comfort and may increase compliance with splint use.[9]