Acute hand injury splinting - the good, the bad and the ugly

Abstract

Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting. This article aims to provide guidance for frontline staff on the management of hand fractures, with particular emphasis on the appropriate nonoperative care to avoid any unnecessary morbidity.

Keywords: Fractures; Hand injury; Splints.

Figure 1

Flow chart to aid in the assessment of operative or nonoperative management

Figure 2

(a) The cam shape of the metacarpal head leads to the collateral ligaments becoming taut in flexion. (b) A well-positioned Edinburgh splint in the ’safe’ position

Figure 3

The wrist is flexed, the metacarpophalangeal joints are almost straight and the interphalangeal joints flexed, as the plaster is too short to control them

Figure 4

This short splint does not flex the distal interphalangeal joint to reduce this flexor digitorum profundus avulsion

Figure 5

The volar splint shown here may exacerbate the dorsal subluxation and it is too short to control the metacarpophalangeal joint

Figure 6

This intra-articular condylar split is not controlled by this poorly applied wrap around splint

Figure 7

(1) You will need scissors, elastoplast and the appropriate width aluminium splint. (2) Place the uninjured hand in the desired position for splinting and bend the splint to conform with this position. (3) Trim the splint to size and round off and cover any sharp edges. (4) Secure the splint in place with further Elastoplast. (5) Note that the level of the bend is in line with the distal palmar crease

Figure 8

(1) Dorsal splint. (2) Proximal interphalangeal joint extension block splint. (3) Distal interphalangeal joint extension block splint