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Splint Design: Circumferential Wrist Orthosis
Objectives of the Splint: Immobilization of the wrist joint for restriction of motion, pain relief, joint alignment, functional support, and/or positioning for healing.
A variety of acute and painful wrist and hand pathologies may require immobilization with a circumferential wrist immobilization orthosis.
Consider patients with the following diagnoses:
- Acute wrist fractures
- Acute TFCC ligament injuries
- Acute arthritic flare-up and inflammation
- Complex Regional Pain Syndrome (CRPS)
- Post-operative tendon transfers, arthroplasties, and osteotomies
- Stiff finger joints requiring dynamic and/or static progressive traction
The circumferential wrist orthosis, enveloping both volar and dorsal surfaces of the forearm, can be extremely rigid and strong, allowing for excellent fracture stabilization, post-operative protection, and extreme support. The therapist can utilize a 1.6mm (1/16)” or 2.0mm (1/12”) thermoplastic material because there is stabilization on both volar and dorsal wrist joints as well as lateral protection. A circumferential splint is typically not as heavy or as bulky as a clam shell design, which includes both a volar designed splint and a dorsal splint placed on top. And it is much easier to don and doff than the clam shell design.
The circumferential design may also help with edema management, providing even compression all around the swollen extremity, along with circumferential strapping, and this can be further enhanced with a compression sleeve worn underneath the orthosis. A circumferential orthosis makes an excellent base for all outrigger attachments, (either on the volar and/ or dorsal side) because it does not migrate distally with force directed on the fingers.
Circumferential splints to support the wrist on both volar and dorsal forearm surfaces are typically fabricated from thermoplastic material of 2.0mm, or 2.4mm (1/12” or 3/32”) thickness. This easily provides adequate support for most adults, and creates a lighter weight and more comfortable splint. But 3.2mm or 1/8” thick materials can be used when needed (due to size of extremity, etc).
Materials with excellent elastic stretch and full memory are well suited for this orthosis. And it is extremely beneficial to select a non-stick coated material for ease in separating the overlapping ends when cooled. The non-stick coated materials do bond together temporarily when heated, allowing the therapist to position the extremity as desired using two hands. Then the overlapped material ends can be popped apart when the material has cooled and hardened. Excess material can be trimmed away easily.
Elastic products have the unique characteristic of “memory” which is important when splints need to be remolded over time. Orfit Industries offers the following products with excellent elastic stretch, non-stick coating and full memory:
In addition, Orfit Industries offers precut circumferential splints, called Gauntlet Immobilization Splints in beautiful and bright colors for quick and easy fabrication. Make sure to order the correct size by measuring the width at the MCP joints.
Instructions for this design can be accessed in our new Educational Corner by the following link: http://www.orfit.com/en/splinting-guide-wrist-immobilization-splint
The advantages of the circumferential wrist splint include firm and secure immobilization, use of a thin material, decreased chance for migration of the splint distally, and circumferential support to help with edema management.