From the Guidelines
The best type of splint for a distal ulnar dislocation after reduction is not explicitly recommended due to potential harm, but if necessary, a removable splint may be considered with careful monitoring for adverse effects. When considering the management of a distal ulnar dislocation after reduction, it's crucial to prioritize strategies that encourage normal movement patterns and resting postures before considering splinting, as splinting may prevent restoration of normal movement and function 1. The potential problems with splinting include increasing attention and focus to the area, thereby exacerbating symptoms, increasing accessory muscle use, use of compensatory movement strategies, immobilisation leading to muscle deconditioning, learnt non-use, and increased pain 1.
Some key points to consider in the management of distal ulnar dislocation include:
- The importance of maintaining the reduced position of the distal radioulnar joint (DRUJ) to prevent re-dislocation
- The need for regular follow-up radiographs to ensure the reduction remains stable
- The initiation of a progressive rehabilitation program focusing on wrist and forearm range of motion exercises after the immobilization period
- The gradual return to normal activities over an additional period
However, the provided evidence does not specifically address the best type of splint for a distal ulnar dislocation after reduction, instead highlighting the potential drawbacks of splinting in general 1. Therefore, any decision to use a splint should be made with caution, considering the potential benefits against the potential harm, and with regular monitoring for adverse effects such as pain and skin breakdown.
From the Research
Types of Splints for Distal Ulnar Dislocation
- There are various types of splints that can be used for distal ulnar dislocation, including above-the-elbow casts, below-the-elbow casts, and supination splints 2, 3.
- The choice of splint depends on the severity of the dislocation and the patient's individual needs.
Effectiveness of Different Splints
- Above-the-elbow casts and below-the-elbow casts have been shown to be effective in maintaining reduction of fractures in the distal third of the forearm in children, with similar complication rates 2.
- Supination splints have been shown to be effective in increasing supination range of motion in patients with limited supination, and can be worn distal to the elbow without restricting elbow flexion and extension 3.
- Static progressive splinting has been shown to be effective in helping patients with posttraumatic elbow stiffness regain functional motion and avoid operative treatment for stiffness 4.
Considerations for Splint Selection
- The type of splint selected should be based on the individual patient's needs and the severity of the dislocation.
- Factors such as residual angulation after reduction and combined radial and ulnar fractures should be taken into account when selecting a splint 2.
- The goal of splinting should be to maintain reduction, promote healing, and restore functional motion to the affected joint.