Question

Describe the fabrication process for a volar or dorsal wrist orthosis.

Answer 1

PATTERN CREATION

1.Consider volar design if the patient has dorsal wound / incision or extruding pins to allow for air circulation.
2.Mark for proximal border at volar wrist crease.

3. Allow extra one fourth to half of material around the borders , depending on digit circumference.

4. Be sure proximal portion of the orthosis has adequate surface area for strap application.

5. For SF, consider including RF to provide greater protection , better stabilization , improved comfort.

6. Draw pattern with fingers slightly abducted. Be sure to provide to provide enough surface area to accomodate all immobilized digits. Remember , material can always be trimmed away after initial molding is completed.

REFINE PATTERN

1. Proximal border should allow full wrist motion.

2. Radial border should allow nearly full thumb motion.

3. Lateral borders of the involved digits should encompass two third circumference of digit to prevent undue compressive stress from straps and maximize rigidity. If borders are too generous , there may be too much digit mobility allowed within orthosis.

4. Allow adequate room in digit web space areas to allow unrestricted motion of unaffected digits.

5. May modify pattern to exclude PIP and / or DIP joints if necessary.

OPTIONS FOR MATERIALS

1. Coated material will allow for over-lapped ulnar border to pop apart after setting fully.

2. Perforated thermoplastics may prevent skin maceration , consider using them for patients who require full time orthosis use.

3. Materials that can be reheated and remolded several times are a good option if ongoing modifications become necessary to accommodate for fluctuations in edema, changes in motion or bulk of dressings.

CUT AND HEAT

1. Position patient's forearm supinated for gravity assisted nolding.

2. If using elasticized wrap or dressings under orthosis , apply to digit before heating material .

EVALUATE FIT WHILE MOLDING

1. Lateral borders of the digit should form a deep trough which will act to strenthen and support the molded orthosis.

2. Remember that when addressing index finger , thumb mobility is somewhat hindered because of necessary contouring about thumb web to obtain proper stabilization.

STRAPPING AND COMPONENTS

1. Apply straps at DIP joint , over PIP joint proximal phalanx , at over-lapped ulnar border , and about wrist to prevent migration.

2. Consider using rivets to secure one end of proximal strap to minimize space needed for hook material.

3. Padding under proximal phalanx strap may reduce migration and rotation, maintain MCP joint position and improve comfort.

SURVEY COMPLETED ORTHOSIS

1. Smooth material borders , avoid rolling or flaring which may irritate adjacent soft tissues and web spaces or interfere with unaffected /adjacent joint movement.

2. Check mobility of uninvolved joints.