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Do Prefabricated Splints Limit Wrist Motion as well as a Traditional Cast? A Pilot Study
Karan Patel, MD1; John Palsis, MD2; Nina Lara, MD3; Paulo Castaneda, BS3; Alex McLaren, MD3
1Mayo Clinic, Phoenix, AZ; 2Medical University of South Carolina, Charleston, SC; 3Banner University Medical Center, Phoenix

Introduction: Prefabricated high performance wrist splints have been used in the treatment of minimally angulated distal radius fractures in children with improved clinical outcomes, high patient acceptance and decreased cost. Similar incentives are present to use prefabricated high performance splints for adult injuries, however outcomes have not been documented. Limitation of wrist motion is felt to be the determinant for clinical success in non-operative management of minimally distal radius fractures. The purpose of this study is to quantitatively determine wrist motion under immobilization by a high performance wrist splint, compared with other forms of immobilization.

Methods: Skeletal motion under five immobilization conditions was studied in six normal young adult subjects using the Motion Monitor , motion analysis system. Subjects were instrumented with seven high-fidelity six degrees of freedom Ascension electromagnetic trackers (1. Lister's tubercle, 2. thumb P1, 3. index P3, 4. long finger metacarpal, 5. lateral humeral epicondyle, 6. mastoid process, 7. C7 spinous process, 8. control tracker placed on the table). Subjects then performed six motion tasks (palmar/dorsiflexion, radial/ulnar deviation, supination, pronation) under five immobilization conditions (no immobilization, thumb spica cast, high performance thumb spica splint, high performance wrist splint, and a pharmacy wrist brace).

Results: There were four male and two female study subjects ranging in age from 25-32 years. Percent reduction in motion from baseline (no immobilization) was calculated for each immobilization type and each motion. Using ANOVA, no significant difference was found in percent reduction between the thumb spica cast, high performance thumb spica splint, and high performance wrist splint for palmar/dorsiflexion, radial/ulnar deviation, supination, or pronation (see figures). Pharmacy wrist brace was inferior to the other groups in palmar/dorsiflexion and radial/ulnar deviation. Figure 1: Dorsiflexion for one subject with different immobilization conditions

Discussion: We studied skeletal wrist motion under various splint/cast immobilization types to determine the relative immobilization efficacy of each to limit motion. Limitation of motion is the therapeutic effect considered to be important in achieving healing without displacement for minimally displaced fractures of the distal radius. A removal, moldable prefabricated high performance splint limits motion of the wrist in adults similarly compared to a surgeon applied thumb spica cast. We have developed a novel methodology to study skeletal motion under joint/cast immobilization using motion analysis, which may be applicable to a multitude of clinical questions at other anatomic sites.


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