Orthotics and Prosthetics: Shoulder Immobilization Devices

Splinting Techniques for the Burn Patient

• A splint is an external device that maintains joints in optimal length and supports burned extremities to prevent deformity.
• Aims of applying splints:
  • Support burned extremities
  • Maintain joint position
  • Correct and prevent deformities

Characteristics of Splints

• Non-toxic
• Light in weight
• Made from non-absorbent material
• Padded over bony prominence
• Easy to shape
• Firm enough
• Fabricated from non-expensive material

Significance of Splinting Techniques

• The treatment of severe burn cases focuses on:
  • Patient survival
  • End cosmetic appearance
  • Functional outcomes
• Splinting techniques play an important role in preserving functional outcomes in combination with different treatment available.

Uses of Splints in Burn Treatment

• Acute phase:
  • Splinting required only when damage to tendons and joints is suspected
  • Immobilize and provide support of affected body parts
  • Non-conforming and non-constrictive securing should be provided due to fluctuation of edema
• Wound healing phase:
  • Prevent development of contracture and disruption of newly skin graft
  • Avoid interfering with healing as a result of improper fit or placement
• Rehabilitation phase:
  • Reduce contracture non-surgically, prevent deformity, and maintain natural body contours
  • Combined treatment of splints, exercise, and pressure is required
  • Maintain sustained stretch to scar tissue
• Reconstructive phase:
  • Splints applied following the release of contractures or reconstructive procedures for restoring function and cosmoses
  • Splints are molded directly to the site and should be monitored for evidence of wound maceration or break down

Splinting Indications

• Protection of anatomical structures:
  • Stabilize joints to eliminate or reduce external forces
  • Splint joints in functional position and tendons in slack position
  • Special attention to moisten dressing to exposed tendon to prevent drying
• Preservation of skin graft integrity:
  • Establish circulation between underlying wound bed and transplanted graft
  • Prevent motion of the joints which locate under or near the grafted area
• Restore of function:
  • Early non-operative resolution of contractures provided by sustained stretch and pressure
  • Combine with serial splinting to maintain gained R.O.M

Requirements for All Splints

• Proper fit:
  • Not too loose or too tight
• Secure application:
  • Avoid pressure necrosis or nerve compression
• Avoidance of pressure over a bony prominence:
  • Dome the splint section over the prominence if possible
• Periodic removal:
  • Remove for wound care only
  • Prolonged static immobilization can cause joint stiffness, muscle atrophy, or contracture
• Daily checking and re-evaluation:
  • Changes in edema and changes in the bulk or type of dressings may require daily splint correction
  • Splint effectiveness also changes as the patient's status changes
• Cleansing with each re-application:
  • Prevent possible wound contamination

Types of Splints

• Static or dynamic splinting depends upon the stage of tissue healing
• During the early inflammatory stage, static splints are useful
• During the proliferative stage of tissue healing, both dynamic and serial static splints may be indicated

Custom Design Halo Neck Splint

• Made from thermoplastic material
• Molded directly to the site

Watusi Collar

• Series of cylindrical plastic tubes encircle the neck
• To increase degree of neck extension, add additional tubes
• Advantages:
  • Applied good contact pressure on the scar tissue
  • Easily adjusted
  • Maintain extension and prevent lateral flexion
  • Can be applied over simple dressing
• Disadvantages:
  • Occlusive monitoring needed for signs of maceration of wound
  • Ridged effect in scar tissue
  • Allergies to certain material as latex

Philadelphia Collar

• Prefabricated circumferential foam or semi-rigid positioning material (orthosis)
• Advantages:
  • Commercially available
  • Easily applied
• Disadvantages:
  • Temporary used
  • Occlusive (pressure point on clavicle)
  • Only minimal dressing can be worn under the collar

Ear Region

• Anticipated deformity: Folding of helix
• Secondary problems: Auricular chondritis, pressure on damaged ears
• Splints:
  • Semi-rigid oxygen mask
  • Ear donuts

Mouth Region

• Anticipated deformity: Microstomia, ectropion of upper and lower lips
• Secondary problems:
  • Decreased horizontal and vertical excursion
  • Difficulty in mastication
  • Altered speech
• Splints:
  • Microstomia prevention splint
  • External traction hook
  • Orthodontic pressure appliance

Shoulder and Axillary Regions

• Anticipated deformity: Shoulder adduction, extension, and internal rotation
• Secondary problems: Development of kyphosis
• Splints:
  • Axilla or air plane splint
  • Shoulder abduction brace
  • Clavicular strap or brace
  • Spinal support

Elbow and Knee Region

• Anticipated deformity: Flexion with pronation deformity
• Secondary problems: Possible ulnar compression, possible peroneal compression
• Splints:
  • Gutter or trough splint
  • Elbow or knee conformer
  • 3 point splint
  • Spiral extension splint
  • Air splint