US 2357323 A
Description (OCR text may contain errors)
Sept. 5, 1944.
D. GOLDBERG ADJUSTABLE SPLINT 2 Sheets-Sheet 1 Filed April: 15, 1944 Dew/d Gold/berg- Sept. 5, 1944.
Filed April 15, 1944 2 Sheets-Sheet 2 Dav/d, GO/dbe Patented Sept. 5, 19 1-4 UNITED .STATES I forr rca AnjUSTABLE. saint David Goldberg, Uniteil' s tates Afifiy,
Camp McCoy, Wis.
Application April 15, 1944, set" rive. 5-1j2 5'3 5 Claims. (01. 128 84) (Granted underit he act of i Mareh as This invention relates generally to "a "splint, but more specifically to an apparatus to be utilized --for the retention of fractured metacarpal bones in a fixed. position after reduction of the fracture.
One object of 'the' invention is toprovide a simple and inexpensive device toeifect the immoam-apparatus for the treatment of transverse and impacted fractures of the last four metacarpal -bones,:which can be easilyapplie'd and adjusted withoutfear of pressure sores, infection,loss of position or deformities.
Stillanother object of the invention is top-ro- --vide aninstrument'of theclas' described which anatomically and physiologically answers the purposeof the general practitioner.
Referring to-the figures in which like'parts are designated by similar reference characters:
Figure lis atop planview'showing theslot'for -longitudinal adjustment of the pressure'plate;
Figure 2 isa front elevation of theapparatus;
Figure 3 is an end elevation showing the 'slot for the vertical adjustment of the finger bracket;
Figure 4 is an end. elevation of a portion ofthe fingersupport and vertically movable bracket;
Figure 5'is a top :plan view ofthe' pressure plate taken on line 55 of Figure 2;
Figure 6 is a sectionalized view of the pressure .platetaken on the line 66 of Figure 5 'showing'a wportion of the universal'connection thereto;
Figure 7 is a front'elevation showing the apparatus attached to the hand of a patient; and
Figure 8 is a front elevation showin relative location of the pressure pad and elevating bracket with respect to fractured metacarpal bone and the adjoining phalanges. p v
Deformities of the hand often occur as the re- -su1t of improper setting of a fractured bone. These fractures are characteristically found in the young or middle aged man, usually the result of a pugilistic encounter, or close hand to hand combat with the enemy in time of war. The
neck of the metacarpal being the smallest and Weakest :portion of the bone, is the most common site of the fracture. The fracture is more frequently transverse in character. I The resulting deformity is that of a depression of the head with dorsal angulation of the fragments. The more dorsal the striking force against the head, the
greater is the depression of the knuckle. The more T i f it t le i lii ,1-.. f f ilf l fth 'l iitii ie xis of the-metacarpal, the greaterthedegree -of impaction. A tangenti al force'results in depresv fsi'oncf hea'd with impaction and angulation of metxa m m rdinarily 'mt'his'typeor f acture, a simple'rojll 6f "gauize'bandaigeis placed in the palm of the The fist is clenchedand immobilized with anothergauae bandage. Some recommend bandaging the handover a tennis ball. More complicatediand "spammed devices have met with success in the hands of others. L. Kaplan in his work entitled The treatment of fractures and dislocations of the hand and fingers; :t'echnic of unpa'dded casts for carpal, metacarpal, and phalangal fractures 'Sur'g. 'Clin, N. America, 1940, 20: [695-1720, explains a device for reducing the racture and holding it in position'by the applicatior' of an unpadded 'ca'st made of two narjdw plaster of Paris splints. The finger is held in extension and pressure is instituted below the headof th'e metacarpal andjabove the angulation whilethe plaster sets. 1H. Meltz'e'r in the article on Wire extension treatment of fractures of fingers and metacarpal bones described in 'Sur'g. Gyn. 05st, 1932, 55137-9, employs skeletal wire "preteen through the proximalphalank. McN'ealy and Lichtenstein :maintain the corrected position astrai'ght dorsal splint as explained in Western Journal of Surgery, 1935, 43:156-61. Wert "seriting specially constructedminiature ice tongs into the proximal phalanx. D, M. Bosworth, in an article on the internal splinting of fractures of th fifth metacarpal, in the Journal of Bone Surgery, 1937, 192826, states that the fragments are first reduced and then maintained in position by fi'xing them to the adjacent metacarpal with nonfiexibleheavywires. S. A. Jahss, in his discussion entitled fFr'actures of the metacarpals; a new method of reduction and immobilization in the Journal of Bone Surgery, 1938, 20:17886, maintains the position of reduction by employing pres sure bcneath the head of the flexed proximal ha a a rlwed re m lar. pertain bect 129 that recommended in this paper. G. G. Davis, in
his discussion on the use of a ball splint for hand fractures in the International Clinic, 1928, Ser., 1:182, 8 pl., maintains position over various sizes of specially constructed wooden balls.
Since this type of fracture is usually first seen by the general practitioner, it is invariably treated by him with one of the many simpler methods available. Unfortunately, in this fracture which is so easily reduced, it is ordinarily difficult to maintain the corrected position. In consequence, :many individuals are left with a residual deform- :ity. This deformity in the laborer interferes with his grasp of an implement. The inability to fully flex the affected finger results in a weakness of the fiexion power of the adjacent fingers. The prominent head of the metacarpal in the palm of the hand causes pain when an object such as a tool is grasped. The professional man, too, finds that this deformity interferes with the full use of both the affected and the adjacent fingers. The depression of the knuckle and the prominence on the dorsum of the hand is cosmetically objectionable to the women.
The ball or roll of gauze in the palm of the hand does not counteract but rather emphasizes the angulating pull of the interossei muscles thereby increasing the deformity. Skeletal traction of any form or skeletal fixation introduces the danger of infection and must be considered a specialized procedure. Plaster, as is Well known, cannot be adjusted to exert varying degrees of pressure during the changing phases of the appearance and subsidence of edema and the subsequent development of atrophy. It i too difiicult for the average physician to determine the exact amount of pressure which is necessary to exert upon setting plaster. Too little pressure will result in reangulation during the stage of atrophy. Too much pressure willresult in pressure sores during the swelling stage which ensues within a few hours following the reduction. Constant immobilization of the flexed proximal interphalangeal joint for a period sufficient to see callous on the X-ray film, results in a flexion deformity.
The instrument to be described is devised primarily for application to the most common type of metacarpal fracture. is the simple, transverse, impacted fracture of the shaft;
With the fracture once reduced, the operator will find that very little upward pressure on the head and downward pressure over the distal end of the proximal fragment is necessary to maintain the corrected position. However, an upward force cannot 'be made on the plantar surface of the metacarpal head for any great length of time without the expectation of complications. Pressure of any consequence for four to six weeks in the intervening fiexor tendon sheath would irritate its membrane and result in thickening and adhesions. .In order to eliminate pressure over the flexor tendon sheath, the first phalanx is flexed to a right angle at the metacarpal-phalangeal joint. This places the base of the proximal phalanx beneath the head of the metacarpal. Pressure upward on the proximal phalanx now forces the metacarpal head upwards. The proximal interphalangeal joint is then flexed to an angle of ninety degrees. Very slight pressure exerted upwards against the head of the proximal phalanx easily maintains elevation of the metacarpal head and the corrected position of the fragments. The amount of pressure necessary is merely the equivalent of the angulating force This, as has been stated,
caused by the pull of the interosseous muscle. The armamentarium necessary to maintain the corrected position of the fractured bone consists of the simple and easily applied apparatus described below and one four inch roll of plaster of Paris bandage.
The apparatus comprises a frame member which consists of an elongated rigid bar I0 formed of metal or other suitable material having a straight central or metacarpal portion H, and at either end a finger support, and a wrist or carpal and anterbrachium portion I2 and I3 which are bent at angles of ninety degrees and approximately fifteen deg-Rees, respectively, to the central portion. The central portion II of the bar In is provided with a longitudinally extending slot I4 for the reception of a set screw I5 which is provided with a knurled head I6 and a ball member I! at its lower extremity. The set screw I5 is held rigidly at any fixed position within the longitudinal slot I4 in the bar I0 by awinged lock nut 18 and a circular knurled lock nut I9 as shown in I, 2, 3, I and 8. The ball I1 at the lower extremity of the screw I 5 is engaged by the socket members 20 and H which are attached to a pressure plate 22 provided with a pad or cushion member 23 which contacts the upper surface of the patients hand. The pressure plate may be vertically adjusted by means of the set screw I 5 and lock nuts I8 and I9 to regulate pressure of the pad 23 on the upper surface of the hand.
The finger or phalangeal portion I2 of the bar I0 which extends at ninety degrees to the central portion I I is provided with a longitudinally extending slot 24 which provides for the attachment of an adjustable bracket 25. This bracket'is composed of an angular base member 26 lidably connected to the bar by means of a bolt 21 which may be retained in any position along the slot by tightening the thumb screw 28 which engages the threads of the bolt and increases the pressure on the washer 29 contacting the surface of the bar. The upper surface of the bracket 26 is provided with circular opening 30 for the reception of a bolt 3|, provided with a knurled nut 32 and washer 33 arranged as shown in Fig. 2, and adapted to retain a supporting plate 34 upon the upper surface of the bracket and to permit the angular adjustment of the same thereon. Upon the upper plate 34 is mounted an angularly shaped pad 35, which is bent over the outwardly extending edge of the plate 34, so as to prevent a soft contact surface to the hand of the patient. The height of the bracket 25 and the angularity of the plate 33 may be adjusted so that the finger of the patient may rest comfortably upon the pad 35.
The wrist portion I3 of the bar I0 is provided with three circular openings 36, 3! and 38 for the reception of the screws 39, 40 and 4|. Instead of tapping the holes 36, 31. and 38 as shown the screws may be welded therein if a more permanent attachment is desired. These screws prevent slipping of the plaster of Paris bandage which is wrapped around the wrist and a lower portion of the arm to retain the frame In in a fixed position with relation to the patients hand.
To apply the apparatus the upper and lower screws I5 and 21 are loosened. About five turns of the plaster of Paris splint bandage are taken about the wrist, the bandage being applied directly upon the skin. The instrument is then placed over the involved metacarpal and the remainder of the plaster roll is used to secure the instrument adapted to contact the dorsal surface of theto the wrist. The plaster sets in a few minutes and the instrument is ready for use. During this procedure the patient maintains the corrected position of the hand by placing the index finger of the other hand over the fracture site and his thumb beneathv the head of the flexed proximal phalanx, thus making anassistant unnecessary.
The upper set screw I5 is then adjusted so that the pressure plate rests directly over the metacarpal and proximal to the fracture line. lower support bracket 26 is raised so that it approximates the dorsal surface of the flexed second and third phalanges. The knuckle is thus maintained in its normal prominent position.
If the fifth metacarpal is involved, it will be noticed that the terminal two phalanges will deviate radially. Hence, a third set screw 3| as shown in Figs. 2, 4, 7 and 8 is placed at the lower support in order to adjust it to the proper angle. The lower support 33 is slightly cupped for comfort. The upper plate 22 is supported by a universal joint the parts of which are designated by the numerals ll, and 2|, the universal being used in order to allow for light variations in the size and shape of the hand and still maintain an even distribution of force throughout the'entire lower contact surface whichis covered by the pad 23.
If swelling is present on the day following the application of the device either one or both of the set screws can easily be adjusted and thus avoid pressure necrosis of the skin. It will nevertheless still be possible to maintain the necessary force to counteract the angulating pull of the interossei.
After a few days all swelling will have subsided. Some fibrous union of the fragments will then have taken place. The operator can then hold his finger .beneath the metacarpal head, loosen the lower support and carry the flexed proximal interphalangeal joint through a full range of motion. The finger can also be cleaned with alcohol and the skin protected with any oil or cream. This latterprocedure should be carried out two or three times a week during the entire stage of fixation.
The fragments should be supported for about three to five weeks, or until X-ray evidence shows sufficient callous about the fracture site to prevent the pull of the interossei muscles from reangulating the fragments.
When callous appears adequate and the apparatus is finally removed, there is a complete restoration of position without evidence of deformity throughout any portion of the hand. Two to three days after the removal of the apparatus, patients have been returned to full army duty without any resultant difiiculty.
Modifications of the device, such as increasing the width of the pressure plate 22 and the supporting plate 33 for use in cases where more than one metacarpal bone is fractured, may be made without departing from the scope and spirit of The metacarpal region of the patients hand, and a vertically and angularly adjustable bracket member connected to said depending portion adapted to, support the second row phalanx associated with the fractured metacarpal.
.2. An adjustable splint for use in maintaining fractured metacarpal bones in anatomical alignment after reduction comprising a rigid frame having a central metacarpal portion, a depending phalangeal portion, and an angularly extending wrist portion, a vertically adjustable pressure plate provided with a padded surface adapted to contact the dorsal surface of the metacarpal region of the patients hand, and a vertically and angularly adjustable bracket member provided with a padded surface and connected to said depending portion adapted to support the second row phalanges associated with the fractured metacarpals.
3. An adjustable splint for use in maintaining fractured metacarpal bones in anatomical alignment after reduction comprising a rigid frame hand, and a vertically and angularlyadjustable having a central metacarpal portion, a depending phalangeal portion, and an angularly extending carpal and antebrachial portion, an adjustable pressure plate adapted to contact the dorsal surface of the metacarpal region of the patients bracket member connected to said depending phalangeal portion adapted to retain the fingers of the fractured metacarpals doubled into the palm of the hand, and means in connection with said carpal and antebrachial portion of said frame adapted to retain a plaster of Paris bandage in fixed position. v
4. An adjustable splint for use in maintaining a fractured metacarpal bone in anatomical alignment after reduction comprising a rigid frame having a central metacarpal portion, provided with a horizontal slot, a depending phalangeal portion provided with a vertical slot, and an angularly extending wrist portion, a vertically ad ustable pressure plate, slidably supported within the horizontal slot in the metacarpal port.on of said frame adapted to contact the dorsal suriaoe of the metacarpal region of the patients hand, and an adjustablebracket, siidaoiy supported within the vertical slot in the phalangeal por ion of said frame, adapted to support the second row phalanx associated with the fractured metacarpal.
5. An adjustable splint for use in maintaining a fractured metacarpal bone in anatomical alignment after reduction comprising a rigid frame having a central metacarpal portion, provided with a horizontal slot, a depending phalangeal portion provided with a vertical slot, and an angularly extending wrist portion, a Vertically adjustable pressure plate, shdabiy supported within the horizontal slot in the metacarpal portion of said frame adapted to contact the dorsal surface of the metacarpal region of the patients hand, and an ad ustable bracket, slidably supported witnin the vertical slot in the phalangeal portion of said frame, adapted to support the second row phalanx associated with the fractured metacarpal and means comprising screws projecting from the upper surface of the wrist portion of said frame adapted to retain plaster of Paris bandage in a fixed position.