Splint Fabrication Evaluation Form

OCT2108 Clinical Science 4 - Assessment 1: Splint Fabrication & Analysis
Student name: Jessica Quick
SPLINT FABRICATION EVALUATION FORM
SPLINT INFORMATION
NAME OF SPLINT Functional Wrist Splint (Wrist cock-up splint or wrist splint)
JOINTS IMMOBILISED Wrist
JOINTS MOBILE Left - Elbow, Thumb CMC/MCP/IP, Fingers MCP/PIP/DIP
PRESCRIBED POSITION Wrist extension 15-20 degrees; wrist deviation 0 degrees (neutral); neutral
forearm rotation
POSITION ACHIEVED
SPLINT MODIFICATIONS The clients forearm was placed with their elbow resting on the table and in a
REQUIRED mid-prone position. However, the client found it hard to maintain the position.
This could have been reduced by finding a neutral position such as moving their
chair or laying down which would have made it more comfortable. An
alternative method would have been to have a second OT there to help maintain
this position while molding.
ANATOMICAL PRINCIPLES OF SPLINTING
ARCHES OF HAND The longitudinal, distal transverse and proximal transverse arches of the hand
should be supported by the splint. The splint does contour to maintain the distal
and proximal transverse arch. However, the splint was moulded to tightly to the
proximal end of the longitudinal arch, causing a pressure point. If this splint was
to go to a client, I would reheat the thermoplastic in the pan and re-mould the
splint into the palm gently rubbing my finger along all over the arches.
BONE & TISSUE Potentially the radial styloid, ulnar styloid, CMC joint of the thumb, MCP heads
PROMINENCES and extensor tendons could cause pressure point by this splint. A slight raised
area can be found on my splint for the ulnar styloid due to the placement of the
padding. However, if the splint was to go to a client, I would remold the splint in
the pan and place a larger bit of padding over the ulnar styloid to ensure no
irritation occurs, as well as allowing room for cushioning. The dorsal distal edge
of the splint was edges were rolled to allow full range of movement of the MCP
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joints. The volar side of the thenar hole was not rolled back further enough to
allow the CMC joint to freely move. If this splint was to go to a client, I would re-
mould the splint in the pan and roll the thumb hole further back before
moulding it on the hand to allow full range of movement of the CMC joint. The
dorsal side of the thumb hole is rolled back to much causing the radial styloid
not to be properly moulded over. If the splint was to go to a client, I would
……………. The splint was moulded smoothly over the extensor tendons to
prevent rubbing.
CREASES OF THE SKIN The distal palmar crease was clear to allow full MCP range of motion. However,
the splint was moulded too much to the volar edge of the thenar crease causing
an obstruction of movement. This could be fixed by remoulding the splint in the
pan and rolling the volar edge further back to allow full motion. The volar distal
edge of the splint should have been rolled back slightly to allow full finger
flexion. This edge should heated in the pan and rolled back slightly more.
DUAL OBLIQUITY The splint does has dual obliquity, as when looking at the splint it is longer and
higher on the radial side than the ulnar side. There is also progressive shortening
of the MCP head length.
OVERALL CONSTRUCTION
FORMATION OF SPLINT The thermoplastic should have been cut slightly bigger for the client’s wrist. As a
result, I had to stretch the material to wrap around her wrist, which therefore
ruined the integrity of strength of the splint.
The splint pattern was difficult to visualize on the thermoplastic, which therefore
lead to a poorly designed splint pattern. If a client was to wear this splint, I
would firstly trace the design on to a stencil and then use the stencil as a guide
for the pattern on thermoplastic. This will ensure a well-designed splint is
created to allow for functional fitting.
This also would have contributed to better accurate cutting of the thumbhole, as
the thumb hole was cut to big (Larger than a 10cents piece). If this was going to
a client, I would get a new piece of thermoplastic to recut the thumb and use the
incorrect splint for reinforcement strips. However, if supplies were limited, I
would re-mould the rolled edges of the thumb hole, slightly less back than
0.8cm. This would ensure the thumbhole is not over-stretched, however, may
not provide enough comfort for the client.
It also would have allowed for the distal edge of the splint to be evenly outlined
and traced to ensure the distal plamar crease can allow full MCP range of
motion.
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FINISHED EDGES The finished edges of the splint were quite rough and bumpy (possibly causing
pressure points), due to using the snips to cut the thermoplastic when it dried. If
this was to go to a client, I would heat the thermoplastic (Repeating the heating
phase when thermoplastic becomes dry) and use the scissors to cut it to ensure
smooth edges. The poor quality of the finished edges were also caused by
inadequate heating of the splint edges when folding the edges. This could have
been fixed by dipping more of the material, evenly into the pan using wet fingers
to roll the edges to allow for a smooth finish.
The proximal end of the splint was trimmed to be able to stand up straight,
however, the cut was not even. If this was to go to a client I would smooth the
bumps out by dipping the thermoplastic into the pan and cutting a thin straight
line.
The dorsal seams of the splint was trimmed as straight as possible as I was
unable to cut any more material of the splint. However, if I was to hand this
splint to a client I would have restarted with a fresh thermoplastic as I cut too
much material off. This is evident at the proximal end of the splint as it does not
reach around to the anterior surface of the forearm (Possibly causing pressure
points). If there was a limited amount of supplies, I would have trimmed it as
straight as possible and rolled the edges slightly to prevent extra loss of material.
The corners of the seam were not trimmed off, due to time, which could cause
pressure points. To fix this, I would have used the dry heat gun on the corner
and trimmed them off with a pair of scissors.
STRAPPING The direct placement of the Velcro straps were in the correct location at the
dorsal-ulnar surface of the splint at proximal, middle and distal points.
The Velcro straps ends were not rounded off. This could have been fixed by
using the scissors to curve the ends to avoid bending.
The Velcro straps were also not stuck on the splint near the dorsal seams. If this
splint was to go to a client, I would take the straps off, reheat them with the dry
gun, placing them further back and re-mold the rolled edges in the pan. An
alternative method would also be to dry heat the splint where the Velcro will be
placed to remove the non-stickiness of the thermoplastic. These methods would
allow for more securely stuck straps.
The required length of the Velcro straps was 4cm, whereas, mine was 3cm. If this
was to go to a client I would measure and recut an appropriately lengthened
Velcro strap.
SPLINT MODIFICATIONS The proximal end of the splint was dipped to far into the splint pan, this caused
REQUIRED the splints shape to change and bumps to form. To fix this problem I would re-
mold the whole splint in the splint pan to the clients hand to ensure the
structure is accurate.
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Appendix 1: Photographs of splint
Please insert photographs of your splints on the person you made them on in the splinting tutorials
Photograph 1 Photograph 2
Dorsal view Volar view
Radio-lateral view Ulnar-lateral view
Comments:
(Comment on any issues that effected your splint but were outside of your control e.g. splinting partner had previous injury
affecting joint position or small piece of splinting material was provided for use on a person with large hand)
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Appendix 2: Interview
Please ask the following questions of your splinting partner in the tutorials while they are
wearing the splint you have made them:
How does you splint feel when you’re wearing it?
Is it digging in or rubbing anywhere?
Are there any places where it feels uncomfortable?
Give you hand a gentle shake. Does it feel like the splint will stay on?
Try moving the parts of your hand and wrist that aren’t in the splint. Does the splint still feel
comfortable when you’re moving?
Are there any activities that you think will be particularly difficult to do while wearing your splint?
Given the person’s answers to the above questions, what would you do before sending them
home with your splint? Be specific with your answers.
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SPLINT INFORMATION
NAME OF SPLINT Hand-based Thumb Post Splint (HSTPS)
JOINTS IMMOBILISED Thumb CMC and MCP
JOINTS MOBILE Wrist, Thumb IP, Fingers MCP/PIP/DIP
PRESCRIBED POSITION Thumb positioned in opposition to index finger allowing pulp-to-

pulp pinch (thumb CMC approximately 45 degrees palmar
abduction; open 1st web space; MCP approximately 10-20 degrees
flexion)
POSITION ACHIEVED
SPLINT MODIFICATIONS
REQUIRED
ARCHES OF HAND
BONE & TISSUE

PROMINENCES
CREASES OF THE SKIN The distal plamar crease and wrist crease should be left unobstructed. The half
MCP circumference of my splint is clear of the distal palmar crease and allows
full flexion of the fingers. The half wrist circumference of my splint edges are
rolled and is clear of the wrist crease, allowing full range of motion of the wrist.
The thenar crease is outlined in the splint
The edge of the thenar opening is flared but does impede the thenar crease
slightly. This edge should be heated and flared.
DUAL OBLIQUITY
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FORMATION OF SPLINT She was fitted with a custom-molded circumferential hand-based

thumb CMC stabilizing orthosis, according to a design described by
Colditz (2000), molded from 1.6 mm (1/16 in.) thick black
perforated thermoplastic (Fig. 6). A piece of 1.6 mm (1/16 in.) thick
self-adhesive Plastazote® was applied to her skin over her CMC
joint, prior to molding. During the fabrication, the proximal and
distal edges, and the edge around the thumb-hole, were folded back
1/2 cm (1/4 in.) to create smooth edges and reduce the flexibility of
the orthosis. As the warm thermoplastic was setting, the thumb was
maintained in opposition with the index and long fingers. Once the
material had hardened, the Plastazote® pad was removed from her
skin and applied to the inside of the orthosis, adjacent to her thumb
CMC joint. A pull-back blue Velcro® strap, designed by the first
author, was applied across the dorsum of the hand. Motions of the
wrist, thumb MCP and finger MCPs were unrestricte
FINISHED EDGES
STRAPPING
REQUIRED
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https://books.google.com.au/books?id=cnCCIqO7AuIC&pg=PA118&lpg=PA118&dq=Hand-
based+Thumb+Post+Splint+(HSTPS)+what+joints+are+immobilised&source=bl&ots=rIWhM0-
DMD&sig=ACfU3U0TGi0Q1lzsBSpaOrCNJIkQyxuQtQ&hl=en&sa=X&ved=2ahUKEwj4ppu4-
ZrkAhUyhuYKHddWBEcQ6AEwGXoECAkQAQ#v=onepage&q&f=false
Comments:
(Comment on any issues that impacted your splint but were outside of your control e.g. splinting partner had previous injury
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golfing, holding hard cover books to read, brushing my teeth and holding a frying pan
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SPLINT INFORMATION
NAME OF SPLINT Resting Splint
JOINTS IMMOBILISED
JOINTS MOBILE
PRESCRIBED POSITION wrist extension 20-30 degrees; MCP flexion 35-45 degrees; IP
flexion 10-20 degrees; thumb CMC 45 degrees palmar abduction
POSITION ACHIEVED
REQUIRED
ARCHES OF HAND
BONE & TISSUE •

PROMINENCES Ulnar styloid
•
Radial styloid
•
MCP, PIP & DIP joints
of the fingers
•
CMC, MCP & IP joints
of the thumb
•
1
st
web space
•
Extensor tendons
CREASES OF THE SKIN
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DUAL OBLIQUITY
FORMATION OF SPLINT
FINISHED EDGES
STRAPPING
REQUIRED
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Comments:
(Comment on any issues that impacted your splint but were outside of your control e.g. splinting partner had previous injury
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OCT2108 Clinical Science 4 - Assessment 1: Splint Fabrication & Analysis

Student name: Jessica Quick