Professor Gary HooperHead of Department

Orthopaedic Surgery

Musculoskeletal Medicine

Christchurch School of Medicine

8:30 - 9:25 WS #68: Plaster and Splint Workshop - Fractures and

Hand/Finger Injuries

9:35 - 10:30 WS #78: Plaster and Splint Workshop - Fractures and

Hand/Finger Injuries (Repeated)

RN Liz WyllieRegistered Nurse

Orthopaedic Outpatient Department

CDHB

Christchurch

Ms Kerry CraggHand Therapist

Hand Therapy Unit

Christchurch Hospital

Christchurch

Managing Common Hand Injuries

Liz Wyllie OOPD Christchurch

Metacarpal Fractures

Position of safe immobilisation (POSI)

Assessing the injured hand

• Check the fingers for rotation by getting the patient to form a loose fist

• Check the nails are all following the same plane and there is no scissoring

• Compare with the other hand

• Rotation must be corrected if present using traction prior to casting or splinting

• Check the patient is able to extend finger to neutral

Treating Metacarpal Fractures

• Neck of M.C. fracture reduction can be achieved by traction and volar pressure under the metacarpal head with dorsal counter pressure more proximally

• Shaft of M.C. fracture reduction requires traction and pressure along the M.C. dorsally

• Base of metacarpal fractures can be reduced in a similar way, but may require further imaging afterwards to confirm the joint is enlocated and congruent.

• Hand fractures, like fingers, generally heal quickly and a maximum of 4 weeks immobilisation is required

• Smoking can delay union and may necessitate longer casting

Products we Use

• One Step

• Plaster Slab

• Plaster rolls

• Nemoa

• Delta Light

• Felt for Moulding

• Padding

• Bandages

Volar Slab • New injuries while swollen can be treated in slab’s not full casts

• We normally use a local block prior to reducing acute fractures

• In Bone Shop we apply volar casts to the metacarpal heads only and buddy strap the fingers to prevent rotation. This allows movement of the MCP’s preventing stiffness

• We don’t use any stocking under casts for new injuries

• Felt padding is applied at the point where moulding will take place to prevent pressure sores

• This is one cast where finger prints are okay!

Cobra Casts

• These casts are also frequently used for metacarpal fractures

• Fingers should have padding wrapped between them prior to casting to prevent maceration

• The hand must be in the POSI to safely rest the soft tissues and facilitate faster rehab after casting

• It is easiest to get the patient to hold their hand in this position for you.

Full casts

• Complete casts can be applied, but plaster should be used acutely and the cast split to allow for swelling

• These can then be completed at 1 week post injury with synthetic

• The same cast can remain on for the whole time

• A full synthetic cast can be applied once swelling is reduced provided there is equipment available to remove it safely

Thumb Injuries

Treating Thumb Injuries

• The most common injuries we see for thumbs are metacarpal fractures and Ulna Collateral Ligament (UCL) Injuries

• Xray should be taken before stressing the UCL if there is an avulsion fracture it should not be stressed as this can displace the fracture

• When testing the UCL the thumb should be stressed flexed to isolate the tendon

• The other thumb should be assessed first for a comparison

• If there is significant laxity a thumb splint or cast will be needed for 3 weeks

• If there is no end point or uncertainty they should be referred for further management

Video of testing UCL

Scaphoid Fractures

Treating Scaphoid Injuries

• Scaphoid fractures are treated in below elbow casts without the thumb included in Bone Shop unless indicated by pain on thumb movement

• Scaphoids can require extended time in cast to prevent non-union up to 12 weeks

• Clinical scaphoid fractures with tenderness in anatomical “snuff box” and on thumb loading but no radiological changes should be treated either in a wrist splint if not too sore or cast

• They should return in 10 – 14 days for re-xray and examination as the fracture may not show up initially

Splints for Wrist

• Minor avulsions from other carpal bones can also be treated in a wrist splint for comfort

• We have Velcro wrist and thumb splints that come in several sizes and can be used for either side and hand therapy can also make thermos plastic splints.

• Thumb splints can be useful for minor sprains also without compromising other joints

References

• Bone Shop House Surgeon Orientation Guide, Orthopaedic Outpatient Department, Christchurch Hospital

• Wheeless’s Textbook of Orthopaedics

• Occupational Therapist, Juliet Schneemannhttps://www.slideshare.net/anti_banme/4position-of-safe-immobilisation

No Disclosures