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A finger splint that will not impair hand function
A FINGER SPLINT THAT WILL NOT IMPAIR HAND FUNCTION* FRANKLIN Attending
Neurosurgeon,
JELSMA,
LouisviIIe City HospitaI
LOUISVILLE,
KENTUCKY
N
OT long ago, due to a severance of the extensor tendon of my index finger, I found myseIf in need of something that wouId maintain extension of my finger yet permit good usage of the rest of the hand. This expIains my interest in finger sphnts. During the first five to seven days after injury, one is perfectly wihing to be quiet, not using the hand, because of pain. After this, there is no good reason why one shouId not be abIe to use the other fingers of the hand, but the usua1 gauze bandage and splints practicaIIy prohibit effective usefuIness. Within a few days, severa factors of greater or Iesser importance presented themseIves as objectionable features in the customary methods of spIinting fingers. These can be mainIy grouped under (I) persona1 discomfort, (2) disabibty due to the mechanica appIiances, (3) physioIogic disturbances due to bandaging and immobihzation of the finger. It is naturaI to expect some pain from a wound deep enough to cut a tendon, but one’s genera1 comfort can be considerabIy promoted by eIiminating a few disagreeabIe detaiIs connected with a cumbersome spIint. It was particuIarIy noted that the extension of the splint beyond the finger made it necessary to guard every movement of the hand, otherwise the spIint wouId strike against something and cause pain in the finger. BuIkiness of the spIint, gauze and bandages between the fingers abducted the adjacent fingers enough to be uncomfortabIe. AIso, the gauze in apposition to the wound adhered to the suture Iine and caused a burning pain when an * From the University
M.D.
attempt was made to use the hand. This pain is due to a shght sIipping or movement of the splint, producing a tug on the raw surface of the wound by the adherent gauze. SoiIing of the gauze bandage required frequent changing, and this is not onIy uncomfortabIe but undesirabIe. Aside from the pain and discomfort as mentioned above, extension of the splint down the paIm of the hand impaired the usage of the entire extremity. Scrubbing is entirely out of the question for weeks, because of the spIints used to maintain extension. It is impossibIe to use gloves over a bandage. Because one cannot scrub or use gIoves any possibility of doing any sort of surgica1 procedure is precIuded. In other words, the spIint keeps one from working. The circuIar bandage wrapped about to maintain the spIint, or the pIaster spIint appIied to the finger impairs the circuIation of the finger, particuIarIy its tip. This undoubtedIy retards heaIing. UnIess the splint or cast is applied quite snugIy there is some di&cuIty in maintaining extension. Some of the above may seem to be but nevertheIess, a11 trivia1 compIaints, added together over a period of time, present a reminder that there shouId be a better way to sphnt a finger and enjoy the security of the splint without enduring so many inconveniences. CoIIodion seemed to answer the purpose better than any other substance used as a spIint. Because it is effective, comfortabIe to the patient, and materiahy diminishes the period of disability, I have deemed it worthwhiIe to caII this method of splinting
of LouisvilIe SchooI of Medicine, 571
Department
of Surgery.
“33
h-
AmcricnnJournalof Sorgcry
JelsmaPFinger
to the attention of men doing general surgery. It may have been used before, but certainly not so much as it should be. Collodion serves the purpose of an> other
view, showing FIG. 1. Anterior apphcation of collodion.
extent
of
spIint and adds many advantages. Some disadvantages are pecuIiar to colIodion alone, but the advantages outweight these. Ordinary coIIodion is used in preference to flexible coIlodion. It must not be too thin. It is applied with a cotton appIicator from the middle of the lateral surface on one side to the middIe of the Iateral surface of the other side, then it is rapidly appIied over the dorsa1 surface of the finger. In the dista1 phaIanx, it is onIy necessary to extend the coIIodion from the tip of the nai1 to just above the second phaIangea1 joint. After one coat has been appIied, a second is applied immediateIy and then a third may be added. It is a good idea to place the two index fingertips in apposition and exert a IittIe pressure, so as to produce a sIight hyperextension. When the coIIodion dries and contracts the extension will be increased; if too pronounced, this causes pain. A slight extension is sufficient, as contraction of the colIodion wil1 produce the proper amount of hyperextension. CoIIodion may be applied directIy over the wound without any gauze beneath it. The coIlodion is steriIe and transparent; the condition of the wound can be watched
Splint through it. If serum which did not occur lodion can easily be it off from one side to
FIG. 2. Lateral view, showing of lingvr and reduction fingertip.
Ill <.thlHL I,. I‘,$‘I should accumula t c, in mq‘ case, the c~)lremoved by peeling the other.
hyperextension of swelling at
It uas noticed that the sweIling was entirely reIieved a short time after the coIIodion spIint was applied. The collodion contracts, causing a reduction in size of the member rather than a sweIIing. I am firmly convinced that the circulation is better with the collodion method of splinting. CoIlodion seems to permit the skin to hea better under it. The epitheIium proIiferates and spreads rather than piIing up aIong the edges of the wound. When gauze is applied to the finger and firm bandage added, there is a tendency for the wound margins and the skin about them to become red and tender. The margins of the wound do not approximate themseIves as firmIy and completely as they do with the coIIodion dressing. The colIodion can be peeIed off readily without pain and can be re-applied in a moment with the utmost ease. One can use the hand naturaIIy and know that the finger is splinted; one can bathe, and there is no Iarge white bandage for everybody to notice and comment on. This Iast sa\.es endless and tiresome explanations.
Neurosurgeon,
JELSMA,
LouisviIIe City HospitaI
LOUISVILLE,
KENTUCKY
N
OT long ago, due to a severance of the extensor tendon of my index finger, I found myseIf in need of something that wouId maintain extension of my finger yet permit good usage of the rest of the hand. This expIains my interest in finger sphnts. During the first five to seven days after injury, one is perfectly wihing to be quiet, not using the hand, because of pain. After this, there is no good reason why one shouId not be abIe to use the other fingers of the hand, but the usua1 gauze bandage and splints practicaIIy prohibit effective usefuIness. Within a few days, severa factors of greater or Iesser importance presented themseIves as objectionable features in the customary methods of spIinting fingers. These can be mainIy grouped under (I) persona1 discomfort, (2) disabibty due to the mechanica appIiances, (3) physioIogic disturbances due to bandaging and immobihzation of the finger. It is naturaI to expect some pain from a wound deep enough to cut a tendon, but one’s genera1 comfort can be considerabIy promoted by eIiminating a few disagreeabIe detaiIs connected with a cumbersome spIint. It was particuIarIy noted that the extension of the splint beyond the finger made it necessary to guard every movement of the hand, otherwise the spIint wouId strike against something and cause pain in the finger. BuIkiness of the spIint, gauze and bandages between the fingers abducted the adjacent fingers enough to be uncomfortabIe. AIso, the gauze in apposition to the wound adhered to the suture Iine and caused a burning pain when an * From the University
M.D.
attempt was made to use the hand. This pain is due to a shght sIipping or movement of the splint, producing a tug on the raw surface of the wound by the adherent gauze. SoiIing of the gauze bandage required frequent changing, and this is not onIy uncomfortabIe but undesirabIe. Aside from the pain and discomfort as mentioned above, extension of the splint down the paIm of the hand impaired the usage of the entire extremity. Scrubbing is entirely out of the question for weeks, because of the spIints used to maintain extension. It is impossibIe to use gloves over a bandage. Because one cannot scrub or use gIoves any possibility of doing any sort of surgica1 procedure is precIuded. In other words, the spIint keeps one from working. The circuIar bandage wrapped about to maintain the spIint, or the pIaster spIint appIied to the finger impairs the circuIation of the finger, particuIarIy its tip. This undoubtedIy retards heaIing. UnIess the splint or cast is applied quite snugIy there is some di&cuIty in maintaining extension. Some of the above may seem to be but nevertheIess, a11 trivia1 compIaints, added together over a period of time, present a reminder that there shouId be a better way to sphnt a finger and enjoy the security of the splint without enduring so many inconveniences. CoIIodion seemed to answer the purpose better than any other substance used as a spIint. Because it is effective, comfortabIe to the patient, and materiahy diminishes the period of disability, I have deemed it worthwhiIe to caII this method of splinting
of LouisvilIe SchooI of Medicine, 571
Department
of Surgery.
“33
h-
AmcricnnJournalof Sorgcry
JelsmaPFinger
to the attention of men doing general surgery. It may have been used before, but certainly not so much as it should be. Collodion serves the purpose of an> other
view, showing FIG. 1. Anterior apphcation of collodion.
extent
of
spIint and adds many advantages. Some disadvantages are pecuIiar to colIodion alone, but the advantages outweight these. Ordinary coIIodion is used in preference to flexible coIlodion. It must not be too thin. It is applied with a cotton appIicator from the middle of the lateral surface on one side to the middIe of the Iateral surface of the other side, then it is rapidly appIied over the dorsa1 surface of the finger. In the dista1 phaIanx, it is onIy necessary to extend the coIIodion from the tip of the nai1 to just above the second phaIangea1 joint. After one coat has been appIied, a second is applied immediateIy and then a third may be added. It is a good idea to place the two index fingertips in apposition and exert a IittIe pressure, so as to produce a sIight hyperextension. When the coIIodion dries and contracts the extension will be increased; if too pronounced, this causes pain. A slight extension is sufficient, as contraction of the colIodion wil1 produce the proper amount of hyperextension. CoIIodion may be applied directIy over the wound without any gauze beneath it. The coIlodion is steriIe and transparent; the condition of the wound can be watched
Splint through it. If serum which did not occur lodion can easily be it off from one side to
FIG. 2. Lateral view, showing of lingvr and reduction fingertip.
Ill <.thlHL I,. I‘,$‘I should accumula t c, in mq‘ case, the c~)lremoved by peeling the other.
hyperextension of swelling at
It uas noticed that the sweIling was entirely reIieved a short time after the coIIodion spIint was applied. The collodion contracts, causing a reduction in size of the member rather than a sweIIing. I am firmly convinced that the circulation is better with the collodion method of splinting. CoIlodion seems to permit the skin to hea better under it. The epitheIium proIiferates and spreads rather than piIing up aIong the edges of the wound. When gauze is applied to the finger and firm bandage added, there is a tendency for the wound margins and the skin about them to become red and tender. The margins of the wound do not approximate themseIves as firmIy and completely as they do with the coIIodion dressing. The colIodion can be peeIed off readily without pain and can be re-applied in a moment with the utmost ease. One can use the hand naturaIIy and know that the finger is splinted; one can bathe, and there is no Iarge white bandage for everybody to notice and comment on. This Iast sa\.es endless and tiresome explanations.