“Not only more gradually, but more effectively too“

Early mobilization has long since been the principle of choice when it comes to dealing with hand injuries. In practice, however, it is often only applied with caution. The reason for this cautious approach is that , while it is good for the joints and muscle chains in the hand to start making gripping movements again soon, these fine structures also need particular protection.   

A plaster cast is usually the method of choice for protecting the wrist immediately after surgery. After the cast has been removed, however, care is still needed, and Bauerfeind has now extended the range of options available for this: long stabilizing orthoses help to ensure more reliable treatment , especially after fractures, and open up various different therapy possibilities depending on stability requirements. With the ManuLoc long and ManuLoc Rhizo long, Bauerfeind can now offer therapeutic solutions for a broader range of patients. One of the driving forces behind the use of the long orthoses is Dr. med. Hubert Klauser, Head of the Hand- und Fußzentrum Berlin (Berlin Hand and Foot Center) in Germany. As a specialist in treating hand injuries, he has already gained some practical experience in using the new “long” orthoses.

Dr. Klauser, why do you need long orthoses to treat the hand?
Dr. Klauser: In our day-to-day work involving hand surgery, we very often deal with injuries to adult males, particularly athletes. These patients need long orthoses, to provide better care for their longer forearms. Different requirements in terms of stability can also be treated in different ways using short or long orthoses. This allows us to increase mobility not only more gradually, but more effectively too.

What kind of indications require long orthoses?
Dr. Klauser: Distal radius fractures, for example, are a very common type of injury in adult men. Around 90 percent of these cases are typical “loco typico” extension fractures. After around a week in plaster, I can provide very effective post-operative follow-up treatment for these injuries with the long version of the ManuLoc orthosis. The ManuLoc long usually covers the fracture point with a significant proximal overhang, which is important. This virtually eliminates the risk of any harmful leverage actions. The ManuLoc Rhizo long lends itself to treating breaks in the radial styloid process, a very common injury that occurs concomitantly with extension fractures. This orthosis enables me to immobilize not only the wrist , but the thumb ray too.

What other indications are there aside from radius fractures?
Dr. Klauser: Another common type of wrist fracture is a fracture of the scaphoid bone. The advantage of treating scaphoid fractures surgically is that the hand can be moved again relatively soon after the union. In most cases, the plaster cast can be removed around a week after the operation, as long as the swelling in the thumb ray and wrist has sufficiently subsided. That’s when the ManuLoc Rhizo long comes into play as part of the follow-up treatment , along with physiotherapy, ergotherapy and medical check-ups. This minimizes the negative effects of immobilization that can occur when a plaster cast is worn for a long time. A purely conservative treatment approach would involve six weeks in plaster, in which case the patient would have difficulty getting their wrist and thumb ray moving again when the plaster is first taken off. The long orthoses are also good for follow-up treatment for tenosynovitis conditions such as the well-known De Quervain syndrome, wrist distortions or arthrodesis to relieve osteoarthritis.

When is the right time to use the orthoses?
Dr. Klauser: It is always a tricky balancing act. If you want to take post-operative management seriously, you have to opt for early mobilization. Advances in medicine, such as locking implants or, indeed, long orthoses, offer us more security. For most patients, keeping the immobilization phase short is a huge relief. However, it is also clear that a joint cannot be moved until the swelling has gone down. After fusion operations to treat osteoarthritis in the carpus, for example, it usually takes at least three weeks for the swelling to subside to a sufficient extent. From a medical point of view, it doesn’t really matter whether the hand has been immobilized for one week or five. It is always interesting when the time comes to bring in the orthosis, as that’s when the functional rehabilitation can finally begin. To go from a plaster cast to absolutely nothing would not be a good idea.

Can the orthosis be used as an alternative to a plaster cast?
Dr. Klauser: In terms of immediate post-operative treatment , plaster casts provide secure immobilization and help swelling to subside more quickly. At this stage, there is no more effective solution. Of course, there are many disadvantages to using plaster casts too. They are uncomfortable and obstruct treatment. Constantly wearing a plaster cast changes a patient’s movement patterns and, due to the muscle chains ascending up the arm, it can cause problems in areas such as the elbow, shoulder and cervical spine. We should therefore aim to open up a window in the treatment process for early functional therapy. I’m a big fan of using compression gloves and motorized continuous passive motion devices to help reduce swelling and support mobility. Using either of these aids requires a plastic splint or an orthosis that works intermittently but can also be put on and taken off again as and when required for therapeutic reasons. Making these devices yourself out of thermoplastic material is time-consuming and expensive. Thanks to the new orthoses, I now have a genuine alternative option in a length that I would not otherwise be able to get hold of.

Images: Anika Büssemeier