A Cost-Effective Stainless-Steel Wire Finger Splint

Stable undisplaced fractures of the phalanges can be treated by immobilization through a splint or neighbor finger strapping. The treatment of these injures varies with the clinical presentation and severity of injury. For protection of distal finger or immobilization of an acute injury, undisplaced fractures of the proximal phalanx and mallet finger, aluminum finger strips, and finger cots are available.[1] [2] Nondisplaced, closed fractures, either transverse or longitudinal, are generally treated with a splint protecting from the tip to the proximal end of the middle phalanx for ~2 to 4 weeks to allow the pain and swelling to subside and to prevent reinjury.[3] There is general consensus that initial treatment of closed mallet fingers should be conservative, wearing a full-time splint keeping the distal interphalangeal (DIP) joint in mild hyperextension for 6 to 8 weeks followed by a 4-week period of night-time wear.[4] Patients wearing stack splints and aluminum splints continuously for 8 weeks have experienced skin maceration problems with splint fit, pain, and breakage.[5] Thus, for the conservative management of diaphyseal and proximal fractures of the middle phalanx, distal fractures of the proximal phalanx, those of DIP and proximal interphalangeal (PIP) joints and for the rupture of the middle slip of the extensor tendon, a finger-long splint is indicated that is designed in this novel customized splint.

This communication presents an indigenously made stainless steel (SS) wire finger splint that is economic and easy to fabricate. The method of fabrication is as follows. Materials required are orthodontic SS wire (19 gauge–0.9 mm), orthodontic universal plier, heavy wire cutter, and 0.5 mm tip permanent marker pen. The finger length is measured and SS wire, which is 12 times more than the finger length, is cut. A proximal ring is bent and continued with four to five longitudinal loops as per the finger’s length and continued with a middle ring and a vertical dorsal arm ending with a distal ring. The tips of the wire are hooked at optimal places as shown in [Fig. 1A]. The finger is inserted in the splint with the rings lying on the dorsal surface and longitudinal loops supporting the ventral surface as illustrated in [Fig. 1B, C]. This wire splint protects the distal phalanx, DIP joint, middle phalanx, and PIP joint.

Fig. 1 (A) Stainless steel wire finger splint (B) dorsal view and (C) ventral view.

There is no in-built stop in the design to prevent slipping of the splint. So, it is advisable to wear it over the finger covered by gauze roll providing a soft mechanical retention of the splint and also by a thin holding gauze roll tied to the base of the splint and around the palm or wrist region. As the splint is made of highly polished round SS wire, it is not prone to cut the soft tissues. It will not strangulate a swollen finger, as it is not tightly fitting and has the leeway of the gauze cloth cover. As the swelling decreases, the splint can be held for an extended period as required, by more gauze roll covering the finger to achieve sufficient retention.

The cost of SS wire in fabricating a single finger splint is only a quarter of an US dollar and involves 15 minutes of wire bending only. The advantages of this finger splint are customization, cost-effectiveness, easy availability, sterilizability, nonallergenic, good strength, and avoids polyethylene, latex, and foam pads. The only disadvantage may be a finger prick injury from the wire tips during fabrication that can be avoided by finger caps. The design also allows application of topical medication, ventilation, quick review, and resplinting. For mallet finger or distal phalanx fractures, this wire splint can be modified in length to keep the PIP joint free to prevent unnecessary stiffness of the joint. The splint is yet to be clinically tried and tested and is open for improvisation. Thus, this customized SS wire finger splint has potential application for finger fractures in resource-limited settings.

Publication History

Article published online:
10 August 2020

• References

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• 2 Ng CY, Oliver CW. Fractures of the proximal interphalangeal joints of the fingers. J Bone Joint Surg Br 2009; 91 (06) 705-712
• 3 Cheung JPY, Fung B, Ip WY. Review on mallet finger treatment. Hand Surg 2012; 17 (03) 439-447
• 4 Maitra A, Dorani B. The conservative treatment of mallet finger with a simple splint: a case report. Arch Emerg Med 1993; 10 (03) 244-248
• 5 O’Brien LJ, Bailey MJ. Single blind, prospective, randomized controlled trial comparing dorsal aluminum and custom thermoplastic splints to stack splint for acute mallet finger. Arch Phys Med Rehabil 2011; 92 (02) 191-198