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Mallet Splints

There are many designs of Mallet splints to treat drop fingers, but this is my favourite. Patients like them, they are easy and cost effective to make, they stay in place and allow for fluctuating swelling, common after injury. 

 

To make these splints you need:

  • Scissors
  • Thin thermoplastic - I used 1.6mm Turbocast, but Orfit, Colourfit, Aquaplast or similar will work as well. The reason I like to use Turbocast is that is has a thin "furry" film on it, which allows some ventilation with less risk or maceration of the skin underneath. But just use off cuts of whatever you thermoplastic you can get your hands on for these small splints.
  • Tape - Make sure it is non elastic. I made sure to cut this skin friendly tape length wise, which is the non-stretchy direction for this tape. Otherwise, any sports tape will work well too.

 

Cut the thermoplastic to fit the finger involved. Ensure that it does not cover more than halfway down the thickness of the finger, to allow for a snug fit. Less than halfway and it will not be strong enough. Heat and mould on the dorum of the finger. (Ensuring a good fit around the nailbed helps). Length wise it should finish just by the PIP joint, still allowing for PIP joint movement.

 

 

Next, apply tape to anchor the splint, starting off with the most distal tape, followed by the most proximal tape. Ask the patient to keep the finger tip on the table to avoid bending the DIP joint. Alternatively, the finger can be taped underneat the splint to begin with, to help keep the DIP joint in extension, and also to protect the skin under the splint.

 

 

Lastly apply the "bonus" tape on on the volar aspect of the finger tip, to ensure the splint stays on really well and the DIP joint is in full extension or slightly hyperextended.

 

 

That's it! Easy as that. 

 

Encourage your patient to keep the finger dry, and if it gets wet, to take it off and dry the skin. Leaving the splint on wet can really get it mucky! 

 

The tricky part is to not bend the DIP joint for a few weeks while the tendon heals.

Here is a pic of how to tape the finger under the splint, or after splint treatment, as an interim light support.

 

Simple Buddy-Straps

There are a variety of buddy-straps on the market, and here is a simple, cost effective one to make yourself. I use 12mm wide (0.5") standard velcro.

 

You need:

Skinny loop velcro - approx 15cm long (6") 

Skinny hook velcro - approx 13cm long ((5")

Sewing machine

 

 

Place the hook velcro on top of the loop, both facing up.

 

 

 

Sew together in the centre, using a straight seam, or elastic seam.

 

 

Put both ends of the hook velcro between the fingers you want to 'buddy'. Cut the hook velcro to be long enough for each half to just cover the whole top of the fingers. Ensure the bottom velcro (the loop) still is straight.

 

Now cut one of the loop velcros at the centre of the uninjured finger. That way it is easy to know how it goes back on. Then cut the other loop velcro so the edges meet. Done.

 

 

The buddy strap can be taken on and off like a ring and would not need to be opened. Just make sure you have not put it on too tightly to start with.

Using X-ray Films for Reusable Splint Patterns

Old x-ray films work well as splint pattern material, for those patterns you use over and over again! The x-ray films are thin and strong, so will last much better than paper patterns. 

 

This happens to be my old shoulder x-ray but you can ask any x-ray department and they might have some reject ones you can have, as long as there are no patient details on them.

 

Just draw the pattern you want onto the film and cut it out!

 

 

 

There are many options to store patterns and I guess it all depends on your working environment. You may have a drawer for all your patterns where they are randomly chucked in, or they may be neatly stored in a folder. Or, if you use a particular pattern on a very frequent basis, you may even want to consider hanging them on the wall by your work bench. Just attach a small velcro dot at the back and have the opposite velcro on the wall.

 

 

 

Room for more patterns!

 

 

Digi-Sleeves

 

 

For many hand patients, oedema can be an issue. Digis-sleeves is a great option to prevent or reduce swelling. And they are easy to make!

 

We usually use Lycra fabric, which comes in a variety of colours. We mainly use the beige or black as it has been the easiest to get hold of and seem to be a popular choice for our patients.

 

Be aware that not all Lycra is the same. If it is too thin, it does not hold compression very well. If it is too thick, it gives too much compression, compromises circulation and also makes it more difficult to move the finger.

 

An easy way to make a few digi-sleeves at the same time is to sew a "sausage" of them and cut them after. You can then adjust them slightly to each patient. This way you will save a lot of time.

 

 

 

If you have an elastic straight seam option on you sewing machine, use that. Otherwise I would recommend a small. tight zig-zag, rather than a straight seam, to allow more stretch on the sleeves.

 

 

 

Make sure not to cut the digi-sleeves too short as this will expose too much of the tip, causing the swelling to be pushed distally, with swollen tips as a consequence. The fabric also tends to shrink/shorten after use, so leaving it a bit longer will keep the fit for longer. Keeping it long enough will also allow the sleeve to be cut down from the proximal end, as the swelling reduces and you want to add more compression.

 

 

 

 

 

Finger Gutter Splints

My favourite thermoplastic material to use for finger gutter splints is Polyform. I usually use the 3mm think (non-perforated) material and thin it slightly when it is warm. You can of course use other materials as well, but what I like about the Polyform is that it conforms so well and you get really nice edges. 

 

Make it long enough so the proximal end of the splint lands just distally to the DPC. That way it is as long as possible, allowing optimal leverage, without restricting MCP joint movement, and it will be more comfortable to wear.

 

When shaping the splint, check the length of the finger, and then do as much of the shaping as possible "in the air", making it slightly straighter than the current PIP joint position. Go back to the patients finger to check the splint several times as it hardens to make sure it still fits.

 

 

Mark out the centre of the PIP joint on the splint and place the self adhesive hook velcro at the back, approximately 2/3 proximally to the PIP joint.

 

Make the splint a few degrees straighter than the current joint position and then adjust it regularly (or even show the patient how to do it themselves). The polyform is easy to adjust by giving it a bend just proximally to the PIP joint. You don't have to heat it up, just use your fingers. Easy!

 

Little fingers can be a bit more tricky to splint as the finger splint has a tendency to twist around the little finger. To help prevent this you might want to consider making the little finger splint with a palmar bar. 

 

In regards to strapping, I have two favourites. If there is a lot of swelling of the PIP joint i like to use the Mafra/Durawrap. It conforms nicely around the joint and helps reduce ane swelling.

 

 

 

I usually sew on a piece of hook velcro to one end of the Mafra to allow more space to attach. Once you have the right tightness of the Mafra, the patient does not have to undo it, but can slide in to the splint, like a slipper. Just make sure they put the strap far back towards the base of the finger. The splint will stay on better that way and it seems to be a more effecient angle for the strap to do its job to help straighten the PIP joint.

 

An other option for strapping is to use Fabrifoam. The advantage with using Fabrifoam is, due to its foam backing, it has less of a tendency to migrate. And because it is elastic, you also get some of that compression to help reduce swelling. The only downside with the Fabrifoam is that it requires more sewing. The Fabrifoam piece needs to be measured quite accurately so that you can attach a folded piece of loop velcro on once side and a piece of hook velcro on the other side.

 

         

 

 

 

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