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Splint Design: Orthoses to Prevent Full Forearm Rotation
Objectives of these Splints
The Muenster and Sugar Tong Orthosis are two useful orthoses indicated to prevent full forearm pronation and supination. Both help to position the forearm in a neutral position so that healing of injured structures can occur.
After trauma and/or surgery of the radius, ulna, Distal Radial-Ulnar joint (DRUJ), proximal radial-ulnar joint and/or TFCC structures, and/or for certain elbow pathologies, it may be important to prevent full active forearm rotation so that the injured tissues and structures can heal without overstretching or shortening of tissue length. Patients with injuries such as TFCC tears, Galeazzi fracture dislocations, DRUJ fractures and dislocations, and ulnar abutment injuries are typically treated with a cast, a Sugar Tong orthosis or the Muenster orthosis to immobilize the forearm.
The Muenster and Sugar Tong orthoses allow for limited active flexion and extension of the elbow, but prevent full forearm rotation, and provide stabilization of the radial-ulnar joint and immobilization of the DRUJ.
A study of the degree to which these orthoses actually limit forearm motion indicated that while the Sugar Tong orthosis is more effective at preventing forearm pronation than the Muenster orthosis, neither orthosis completely limits full forearm rotation (Slaughter et al, 2010). Participants in the study received sensory feedback that they were reaching limitations in forearm range of motion, but were still able to rotate through the forearm arc of motion. However, these participants had no forearm pathologies. Patients experiencing painful forearm motion would be instructed to limit full rotation of their forearm: pain, swelling and post- operative bandages would further limit motion.
- Muenster Orthosis: An elastic based coated material is highly recommended for the Muenster Orthosis. Orfit NS, Aquafit NS (Orfit Natural NS) and Orfit Colors NS in 3.2mm (1/8”) all work very well for this design. The non-stick coating of these products allows the fabricator the ability to pinch the thermoplastic material together at the posterior elbow and on the ulnar border, allowing both hands to position the wrist in slight extension and the forearm in the a neutral posture. A more rigid material can also be used: see product recommendations for the Sugar Tong Orthosis.
- Sugar Tong Orthosis: This orthosis is best made from a long rectangular strip of a more rigid material: Orfibrace, Orfit Eco, or Orfit Eco Black NS in 3.2 mm (1/8″) are recommended. The materials that we recommend for the Muenster Orthosis would also work well for the Sugar Tong Orthosis..
The patient should be standing or seated with the elbow flexed to 90° and the forearm positioned in neutral to fabricate these orthoses. You will need full access to the posterior elbow, epicondyles and wrist for best fabrication technique.
These orthoses should be worn full time immediately after surgery of the involved structures. The patient would be instructed in gentle elbow range of motion exercises.