Patterns

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Chapter Outline

SPLINT PATTERN FABRICATION PATTERN MATERIALS AND EQUIPMENT SPECIFIC PATTERNS Metacarpal Shell

Metacarpal/Wrist/Forearm Shell (Dorsal) Metacarpal/Wrist/Forearm Shell (Volar) Forearm/Elbow/Humerus Shell CONTIGUOUS ADAPTATIONS OF BASIC PATTERNS

Proximal Phalangeal/Metacarpal/Wrist/Forearm Shell

Finger/Metacarpal/Wrist/Forearm Shell (Dorsal)

Finger/Metacarpal/Wrist/Forearm Shell (Ventral)

SEPARATE COMPONENT PATTERNS

Phalangeal Bar

Four-Finger Outrigger

SUMMARY

The transition from the cognitive design process to the actual construction of tangible splint patterns is facilitated by the progression through the hierarchy of design principles. Once the design process is traversed, construction of a workable pattern is simplified. Pattern assembly and connection of the various splint parts may then be carried out until the ultimate configuration of the splint becomes apparent. This allows alterations of shape and size to be governed by individual specifications of the extremity being splinted before actual fabrication of splint materials commences.

In the pattern stage, simple splints with uncomplicated objectives allow for rather routine application of design principles, whereas in the presence of unusually difficult problems a more innovative approach is required. Nevertheless, a progression through the design principles facilitates a more efficient, organized thought process from which practical variations may be made.

The rigid use of standard, unmodified, commercially available patterns is not recommended because this may result in the preparation of a splint without the appropriate adaptation necessary to accommodate individual anatomic variations. With experience comes the knowledge of where and how to incorporate changes in these dye patterns, and the potential hazards of using commercial patterns are diminished considerably (Fig. 21-1). All patterns, whether individually constructed or adapted from a commercial design, should be fitted and checked on the patient before construction of the splint begins, since a poorly conceived or fitted pattern almost always leads to frustration and failure during the subsequent stages of construction, fit, and use.

I SPLINT PATTERN FABRICATION

The fabrication of splint patterns is defined according to the construction methods employed: (1) combining

Fig. 21-1 A commercial pattern must be adapted to the variations of the individual hand before it is used.
Fig. 21-2 Outline pattern construction is more expedient for uncomplicated designs.

of individual splint parts, (2) outlining of the total splint configuration, or (3) taking of specific measurements to form a general pattern shape.

All patterns, like the splints they represent, consist of individual parts that, when combined, form a whole.5 For the beginner or for the experienced individual attempting to translate a difficult splint design into pattern form, taping and combining cutout paper splint parts on the patient's extremity may ease pattern construction. An alternative technique of pattern fabrication, the drawing of an outline of a splint, is more efficient when dealing with familiar, uncomplicated splint designs. The uncut pattern material is first applied to the extremity, and the configuration of the proposed splint outlined according to anatomic landmarks and mechanical considerations (Fig. 21-2).6-9 These two methods of pattern construc tion may be effectively combined to blend the efficiency of the outline method with the specificity of the parts technique (Fig. 21-3). The third method of pattern construction is appropriate only when a stretchable/drapable splinting material is to be used. This less exacting technique of pattern preparation results in a pattern that bears little resemblance to the finished splint. Length and width measurements are frequently the only requirements for this kind of pattern construction because the splint material is draped, stretched, molded, and trimmed during the fitting phase of fabrication (Fig. 21-4).

Experienced clinicians often save special "generic" splint patterns that are easily adapted to a wide range of hand sizes, evolving over time a practical pattern file that increases splint fabrication efficiency. Use of a photocopier allows splint pattern size to be proportionally increased or decreased depending on the hand size. Tracing precut splints is another option to make generic patterns. If a patient is particularly difficult to fit and replacement splints will be needed in the future, it is helpful to save the original splint pattern in the patient's therapy chart. Unfortunately, this may not be possible in some facilities where only approved items are permitted in patient charts.

I PATTERN MATERIALS AND EQUIPMENT

Although pattern materials are of seemingly infinite variety, they possess some common properties. They should be readily available, inexpensive, flexible, clean, and allow easy marking, taping, and cutting. Examples are paper towels, x-ray film, cloth, light cardboard, cellophane, plastic wrap, clear plastic bags, and surgical gloves. The choice of pattern material may be influenced by the splint design, pathologic condition of the extremity, material accessibility,

therapist preference or environmental factors. A pattern for a splint requiring contour would be difficult to make from light cardboard because of its mildly rigid properties and, in contrast, a bar configuration splint pattern out of plastic wrap would be flimsy and could allow alteration of the splint form during transfer to the final splint material. Paper towels are available in most medical offices and therapy departments and are flexible enough to allow contouring. Even the wax papers that separate sheets of boxed thermoplastic materials can be used for pattern construction.10 Cellophane, plastic bags, and plastic wrap provide the unique property of transparency, giving full visibility to underlying anatomic structures, and a surgical glove allows three-dimensional perspective. Paper towels that are provided with sterile surgical gloves also make excellent pattern materials when working in isolation conditions.

Positioning devices1,2 have been advocated in some circumstances when making a single plane pattern proves to be difficult. These devices allow various segments of the extremity to be placed in the desired position, theoretically making tracings and fitting more accurate. However, the final configurations of patterns made with and without a positioning device are similar enough that the addition of the extraneous piece of equipment is usually unwarranted except for special circumstances where the patient is unable to maintain a needed position even for the short time it takes to make a pattern (Fig. 21-5).3,4

If it appears that the amount of hand movement required to construct a pattern will be poorly tolerated by a patient, a pattern may be traced from the

Palmar Abduction

Fig. 21-4 A. Thumb CMC palmar abduction immobilization splint, type 1 (2)

A. As seen in this thumb CMC immobilization pattern design by Kay Carl, OTR, Indianapolis, Ind., measurement patterns often bear little resemblance to the final splint configuration. B. The length between dorsal and volar wrist flexion creases through the first web space is the pattern length. C. The length from the index proximal digital flexion crease to the thumb interphalangeal joint equals the width.

Fig. 21-4 A. Thumb CMC palmar abduction immobilization splint, type 1 (2)

A. As seen in this thumb CMC immobilization pattern design by Kay Carl, OTR, Indianapolis, Ind., measurement patterns often bear little resemblance to the final splint configuration. B. The length between dorsal and volar wrist flexion creases through the first web space is the pattern length. C. The length from the index proximal digital flexion crease to the thumb interphalangeal joint equals the width.

Fig. 21-5 Wrist, finger, and thumb splint pattern made with (A) and without (B) a positioning device.

opposite, unaffected hand, allowing for individual variations such as edema or amputation. This pattern should then be reversed and checked for fit on the injured extremity. If the pathologic condition disallows pattern construction on either extremity as with some burn patients or patients with bilateral injuries, longitudinal and horizontal measurements may be taken (Fig. 21-6), and a hand of similar size located on which a pattern may be made.

I SPECIFIC PATTERNS

Although exceptions exist, patterns are generally employed when constructing those major sections of a splint that directly contact the extremity. These constituent elements may function independently or they may form the foundation for attachment of other splint components. With experience, clinicians develop individualized methods of constructing patterns and preferences for certain pattern materials. While no two clinicians may make patterns exactly alike and designs for hand/upper extremity splints are seemingly endless, the process of constructing patterns depends on a thorough knowledge of anatomy, an understanding of the principles of mechanics, using outriggers and mobilization assists, design, construction, and fit, and familiarity with the physical properties of available splinting materials.11

Many patterns for hand/upper extremity splints are derived from one of four basic configurations consisting of specialized components which provide transverse or longitudinal positioning: (1) metacarpal shell, (2) metacarpal/wrist/forearm shell (dorsal), (3) metacarpal/wrist/forearm shell (volar), and (4) forearm/elbow/humerus shell. Although inclusion of all the potential variations is impractical, descriptions of these basic patterns and some of their more common adaptations are briefly outlined and illustrated in this chapter. It is important to remember that although these patterns reflect basic configurations, they must be specifically adapted to individual patients before being used in the clinic setting. Rote application without consideration of the variations in

Fig. 21-6 The width of the hand at the metacarpophalangeal flexion crease and the length from the wrist flexion crease to the metacarpophalangeal flexion crease on the ulnar aspect of the palm are the two most important measurements to take when attempting to locate a similar-sized hand for pattern construction.

Fig. 21-6 The width of the hand at the metacarpophalangeal flexion crease and the length from the wrist flexion crease to the metacarpophalangeal flexion crease on the ulnar aspect of the palm are the two most important measurements to take when attempting to locate a similar-sized hand for pattern construction.

patient anatomy and pathology would be shortsighted and is definitely contraindicated.

To provide readers with more options, other chapters are referenced when alternate pattern designs are available to those shown in the following sections. Also, many innovative splint patterns for children are included in Chapter 18, Splinting the Pediatric Patient. In the next section of this chapter, commonly used splints are converted into their respective component shells and patterns. Providing visual diversity, anatomic landmarks for each splint illustrated are shown either on the hand/extremity or on the paper pattern. Adaptations to the basic shells and separate component patterns are also illustrated. So that pattern size may be readily adapted, all patterns are photographed on a 4 x 4 square = - inch background. Appendix F presents larger-scale versions of all of the patterns illustrated in this chapter. Shells, splints, anatomic landmarks, patterns, and shell adaptations are presented according to the following order and format:

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