Videos in clinical medicine. Basic splinting techniques

Comparative strength of elbow splint designs: a new splint design as a stronger alternative to posterior splints

BACKGROUND

Musculoskeletal injuries of the upper extremity are frequently treated with temporary external immobilization. Traditionally, long arm posterior splints have been used to limit flexion/extension of the elbow. However, long arm posterior splints have been observed to fail clinically, necessitating a stronger alternative. In this study, we assessed the biomechanical strength of the long arm posterior splint compared with a new spiral splint design.

METHODS

One male and one female participant were placed 10 times in long arm posterior splints and 10 times in spiral splints. Both splint types were subjected to a downward mechanical load of 39.2 N (4 kg) and assessed for a change in both flexion/extension and pronation/supination.

RESULTS

There was no significant difference in starting position or starting flexion/extension between the 2 splint designs. Posterior splints allowed significantly greater initial pronation/supination compared with spiral splints. Both splint groups had significant increases in flexion/extension and pronation/supination compared with their starting ranges of motion. There was no significant difference in the change in pronation/supination between the 2 splint groups. Finally, posterior splints allowed a significantly greater change in flexion/extension compared with spiral splints.

CONCLUSION

Spiral splints offered less initial pronation/supination than long arm posterior splints. Furthermore, spiral splints are able to resist flexion/extension of the elbow after application of a downward mechanical load better than posterior splints, thus suggesting spiral splints are mechanically superior to long arm posterior splints.

Rapid customization system for 3D-printed splint using programmable modeling technique - a practical approach

Background

Traditional splinting processes are skill dependent and irreversible, and patient satisfaction levels during rehabilitation are invariably lowered by the heavy structure and poor ventilation of splints. To overcome this drawback, use of the 3D-printing technology has been proposed in recent years, and there has been an increase in public awareness. However, application of 3D-printing technologies is limited by the low CAD proficiency of clinicians as well as unforeseen scan flaws within anatomic models.

A programmable modeling tool has been employed to develop a semi-automatic design system for generating a printable splint model. The modeling process was divided into five stages, and detailed steps involved in construction of the proposed system as well as automatic thickness calculation, the lattice structure, and assembly method have been thoroughly described. The proposed approach allows clinicians to verify the state of the splint model at every stage, thereby facilitating adjustment of input content and/or other parameters to help solve possible modeling issues. A finite element analysis simulation was performed to evaluate the structural strength of generated models. A fit investigation was applied on fabricated splints and volunteers to assess the wearing experience.

Results

Manual modeling steps involved in complex splint designs have been programed into the proposed automatic system. Clinicians define the splinting region by drawing two curves, thereby obtaining the final model within minutes. The proposed system is capable of automatically patching up minor flaws within the limb model as well as calculating the thickness and lattice density of various splints. Large splints could be divided into three parts for simultaneous multiple printing.

Conclusions

This study highlights the advantages, limitations, and possible strategies concerning application of programmable modeling tools in clinical processes, thereby aiding clinicians with lower CAD proficiencies to become adept with splint design process, thus improving the overall design efficiency of 3D-printed splints.

Assessment of "YouTube" Content for Distal Radius Fracture Immobilization

OBJECTIVE

Distal radius fractures (DRFs) are the most common orthopedic fractures, with >70% of cases treated by closed immobilization using a short arm cast or a sugar tong splint. However, inadequate immobilization is a risk factor for loss of reduction requiring repeat reduction or surgical treatment. Therefore, education of clinical skills for appropriate immobilization of DRFs is important. With the increasing use of web-based information by medical learners, our aim was to assess the quality and quantity of videos regarding closed immobilization of DRFs on YouTube.

DESIGN

Retrospective review of YouTube videos on distal radius fracture immobilization using specific search terms.

SETTING

Identified videos were analyzed for their educational value, quality of the technical skill demonstrated, and overall metrics. Educational value was scored on a 5-point scale, with "1" indicative of low quality and "5" of high quality.

PARTICIPANTS

Not applicable.

RESULTS

Among the 68,366 videos identified, 16 met our inclusion criteria of being in English; performed by a health care professional or institution; and with casting being the major theme of the educational information provided. Of these 16 videos, 6 had an educational value score of 4 or 5, with the remaining 10 having a score ≤3. Although immobilization was demonstrated by cast technician specialized in orthopedics, skills were also performed by orthopedic attendants, urgent care physicians, orthopedic residents, and nurse practitioners. The credentials of the performer in 3 videos were not identified.

CONCLUSION

There is a need to promote high-quality educational videos produced by established medical school faculty members on open, web-based, portals.