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Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 1260 - файл
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Appendices
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appendix
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A
COMMONLY USED SPLINTS
Figure A-1. Mallet/DIP joint hyperextension splint immobilizes the DIP joint in
hyperextension while leaving the PIP joint free to move.
169
170 Appendix A
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Figure A-2. Buddy taping, using either tape or velcro straps, is placed
to allow the adjacent finger to serve as a splint, which still allows joint
motion.
Commonly Used Splints 171
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Figure A-3. A digital dorsal blocking splint is used to maintain
reduction of a PIPJ dislocation or fracture-dislocation; this can be
created using an aluminum/foam splint if available.
172 Appendix A
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Figure A-4. Metacarpal or phalangeal injuries can be immobilized in “neu-
tral,” with the MPJs flexed and the IPJs extended.
Commonly Used Splints 173
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Figure A-5. Ulnar gutter splints can be made of plaster or can be fabri-
cated from thermoplast material depending on patient and injury factors.
Figure A-6. Thumb spica splinting,
whether plaster or thermoplast, should
immobilize at least the MPJ of the thumb.
The IPJ of the thumb sometimes can be left
free to move (if the injury does not include
the EPL, FPL, IPJ, or distal phalanx).
174 Appendix A
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Figure A-7. The stan-
dard volar wrist splint
should allow full MPJ
flexion (fist formation)
to prevent stiffness. If
supination and pronation must be controlled
(both radius and ulna
fractures), a sugar tong
splint (wrapping around
the elbow and extending back to the MPJ
dorsally) should be
applied.
Figure A-8. A wrist and digital
dorsal block splint can be used to
immobilize flexor tendon injuries,
preventing extension of the wrist
and digit, which can cause retraction of the tendon stump or rupture
of repairs.
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B
DIGITAL ANESTHETIC BLOCK
Four digital nerve branches supply innervations to each digit.
There are several reported techniques used to anesthetize these
nerves. The authors prefer the dorsal approach, which is less painful
for the patient.
You will need:
t Betadine (or equivalent)
t 10 cc syringe filled with 1% lidocaine (no epinephrine)
t 25 gauge needle (~1.5 inches)
1. Prepare the digit and web space with betadine solution.
2. Inject 1 cc wheal of lidocaine in dorsal skin next to extensor tendon and just proximal to web space to anesthetize dorsal digital
nerve (Figure B-1A).
3. Insert needle further until it can be seen tenting volar skin.
Inject 1 cc lidocaine to block volar digital nerve (Figure B-1B).
4. Withdraw needle to dorsal skin and target it subcutaneously to
inject a 1 cc wheal at the dorsal skin on the opposite side of the
digit’s extensor tendon.
5. Insert needle through wheal on opposite side of extensor tendon
as far as the volar digital nerve and inject additional 1 cc lidocaine (Figure B-1C).
6. Wait about 5 minutes for the lidocaine to take effect, then test
whether it is working before beginning a procedure.
AB C
Figure B-1
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