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Intrinsic Plus Splint

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Other Names

The intrinsic plus splint[1]
  • Intrinsic Plus Splint

Background

  • This page describes the so-called intrinsic plus splint
  • The splint is named after the intrinsic plus hand position
    • Characterized by MCP flexion, PIP and DIP extension
    • Caused by an imbalance between spastic intrinsic and weak extrinsic muscles of the hand
    • Etiology is varied widely

Indications


Contraindications

  • Absolute contraindications
    • None
  • Relative contraindications
    • Open fractures
    • Injuries with neurovascular compromise

Procedure

Equipment

Preparation

  • Measure plaster
    • Dorsal Slab: Measure from mid forearm to distal fingertips
    • Volar slab: Measure from mid forearm to distal finger tips
    • Each side should be 8-10 layers

Technique

  • Patient position (Intrinsic Plus)
    • Wrist extension: 20–30° of wrist extension
    • MCP: 70–80° flexion
    • PIP/DIP in full extension
  • Stockinette
    • Apply stockinette slightly longer than desired splint length
  • Web roll/ cotton padding
    • Apply cotton padding starting proximally and working distally
  • Plaster of Paris
    • Place the dorsal and volar slabs
    • Place the wrist into intrinsic plus.
    • Maintain this position until the plaster reaches the rigid state
  • Apply more cast padding if needed
  • Flip the stockinette over the edges of the splint
  • Apply the ace wrap
  • Reassess distal neurovascular status

Aftercare

  • Typically non-weight bearing until re-evaluated
  • Advise patient to keep cast or splint clean and dry
  • Do not insert objects into splint/ cast
  • Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
  • Seek further care if unable to control pain at home

Complications

  • Acute Compartment syndrome
  • Plaster burn/ thermal injury
  • Pressure sores
  • Nerve palsy
  • Vascular compromise
  • Splint dermatitis
  • Permanent joint stiffness
  • Skin infection

See Also


References

  1. Hodax, Jonathan D., Adam EM Eltorai, and Alan H. Daniels, eds. The Orthopedic Consult Survival Guide. No. 25571. Springer International Publishing, 2017.
Created by:
John Kiel on 25 June 2023 16:53:01
Authors:
Last edited:
25 June 2023 18:17:11
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