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A modified splint for mallet finger
A Modified Splint for Mallet Finger H. G. STACK, Brentwood,
Essex.
During and after the war, the standard treatment for mallet finger was that advised by Sir Reginald WatsonJones, (1943) with the finger held in flexion at the proximal interphalangeal joint, and with some hyperextension of the distal joint, this position being held by a plaster of Paris splint. The method was introduced by Smillie (1937). The polythene mallet finger splint was first developed out of a personal experience when I had been unfortunate enough to sustain a mallet finger. A friendly representative from Smith & Nephew travelled across London in the Great Smog of 1952 to apply a ‘Glassona’ splint which was made in the traditional shape. As a result of getting the finger wet, intolerable itching developed due to maceration in the volar skin fold of the proximal interphalangeal joint. Reduction of the splint to a simple support for the distal joint in extension allowed normal activity and produced a satisfactory union in the torn tendon.
Fig. 1 shows the modified splint with the added spaces for extra ventilation, on the left in clear plastic, which is therm0 plastic and on the right in skin-tone plastic.
One patient, a Warrant Officer Engineer in the Royal Navy, under my care, replaced his plaster with a small metal splint he made himself. This was as long ago as 1946. He spoiled the effect by taking it off frequently to show his friends. The plastic splint was developed so that it could be maintained in position with a single band of strapping. It is possible to use a Velcro strap, as provided by the manufacturer, provided the patient can keep it on. Rather more careful supervision is required, particularly in the early stages. The present modification with two large windows instead of a number of small holes has been introduced for two reasons. Firstly to reduce the area of skin covered by the plastic, to allow evaporation of moisture and sweat more easily and secondly to allow contact against the pulp surface of the finger. It is possible to hold small objects with the pulp and it is noticeably more comfortable driving a car. It is made in graded sizes. If one size appears too tight and the next larger too loose, the latter can be made more comfortable and effective by the use of plastic foam padding. Some surgeons have asked that the splint be made in greater hyperextension in order to obtain a greater correction. It has been my experience that the extension is enough to produce an adequate correction, and that most if not all of any remaining droop will take up in Received for publication January, 1986. H. G. Stack, F.R.C.S. c/o The Pilgrims Press,
VOL. 11-B No. 2 JUNE
1986
Fig. 2
shows two views of the splint in position, application of strapping or a Velcro band.
before
the
These splints are made by Link, Barkhausenweg 10, Hamburg 63, West Germany and are obtainable in Great Britain from Stille-Werner, (UK), Goldwater Park Trading Estate, Woking, Surrey GU21 ILR, England, and in the U.S. Link America, Inc., 10 Great Meadow Lane, E. Hanover, NJ 07936.
the succeeding months. There is a danger if hyperextension is maintained too strongly that some relative avascularity of the skin over the dorsum of the joint may develop which may lead to persistent tenderness. It is possible to produce some extra extension by padding the standard splint beneath the pulp. References SMILLIE, I. S.
(1937). Mallet Finger. British Journal of Surgery, 24: 439-4.45. and Joint Injuries. 3rd Edition. Edinburgh and E and S Livingstone (1943).
WATSON-JONES,R. Fractures Caton
House,
Ongar,
Essex
CM5
9RB.
London.
263
Essex.
During and after the war, the standard treatment for mallet finger was that advised by Sir Reginald WatsonJones, (1943) with the finger held in flexion at the proximal interphalangeal joint, and with some hyperextension of the distal joint, this position being held by a plaster of Paris splint. The method was introduced by Smillie (1937). The polythene mallet finger splint was first developed out of a personal experience when I had been unfortunate enough to sustain a mallet finger. A friendly representative from Smith & Nephew travelled across London in the Great Smog of 1952 to apply a ‘Glassona’ splint which was made in the traditional shape. As a result of getting the finger wet, intolerable itching developed due to maceration in the volar skin fold of the proximal interphalangeal joint. Reduction of the splint to a simple support for the distal joint in extension allowed normal activity and produced a satisfactory union in the torn tendon.
Fig. 1 shows the modified splint with the added spaces for extra ventilation, on the left in clear plastic, which is therm0 plastic and on the right in skin-tone plastic.
One patient, a Warrant Officer Engineer in the Royal Navy, under my care, replaced his plaster with a small metal splint he made himself. This was as long ago as 1946. He spoiled the effect by taking it off frequently to show his friends. The plastic splint was developed so that it could be maintained in position with a single band of strapping. It is possible to use a Velcro strap, as provided by the manufacturer, provided the patient can keep it on. Rather more careful supervision is required, particularly in the early stages. The present modification with two large windows instead of a number of small holes has been introduced for two reasons. Firstly to reduce the area of skin covered by the plastic, to allow evaporation of moisture and sweat more easily and secondly to allow contact against the pulp surface of the finger. It is possible to hold small objects with the pulp and it is noticeably more comfortable driving a car. It is made in graded sizes. If one size appears too tight and the next larger too loose, the latter can be made more comfortable and effective by the use of plastic foam padding. Some surgeons have asked that the splint be made in greater hyperextension in order to obtain a greater correction. It has been my experience that the extension is enough to produce an adequate correction, and that most if not all of any remaining droop will take up in Received for publication January, 1986. H. G. Stack, F.R.C.S. c/o The Pilgrims Press,
VOL. 11-B No. 2 JUNE
1986
Fig. 2
shows two views of the splint in position, application of strapping or a Velcro band.
before
the
These splints are made by Link, Barkhausenweg 10, Hamburg 63, West Germany and are obtainable in Great Britain from Stille-Werner, (UK), Goldwater Park Trading Estate, Woking, Surrey GU21 ILR, England, and in the U.S. Link America, Inc., 10 Great Meadow Lane, E. Hanover, NJ 07936.
the succeeding months. There is a danger if hyperextension is maintained too strongly that some relative avascularity of the skin over the dorsum of the joint may develop which may lead to persistent tenderness. It is possible to produce some extra extension by padding the standard splint beneath the pulp. References SMILLIE, I. S.
(1937). Mallet Finger. British Journal of Surgery, 24: 439-4.45. and Joint Injuries. 3rd Edition. Edinburgh and E and S Livingstone (1943).
WATSON-JONES,R. Fractures Caton
House,
Ongar,
Essex
CM5
9RB.
London.
263