Safe splinting in hand surgery

We read this technical point with interest in the March 2010 edition of the Annals. The authors describe a useful method for placing a stockinet bandage around plaster-of-Paris when preparing a hand splint. A similar technique, using a Tubigrip bandage, has been used by the senior author for many years. Wewere, however, concerned to see the position of the splint demonstrated in Figure 2 of the article. This demonstrates the wrist, metacarpophalangeal (MCP) and interphalangeal (IP) joints in full extension. The correct position in which to immobilise the hand safely following injury or surgery is the position of safe immobilisation (POSI), also called the intrinsic-plus or Edinburgh position, originally described by JIP James.^1,2 The POSI position places the wrist in 0-30° of extension, MCP joints in 70-90° of flexion and IP joints in full extension.³ This ensures pretension on the collateral ligaments of the wrist, and theMCP and IP joints of the hand, thereby avoiding stiffness and contracture (Figs 1 and 2).

Figure 2.

Schematic representation of the POSI position. Reproduced with kind permission from AO Publishing.⁴

Figure 1.

The POSI position for safe hand splinting.

Increasingly, non-specialist healthcare workers are involved in the delivery of first-line care to patients with hand injury and infection. We wish to stress the importance of optimum splintage of such patients. The simple technique described above is a useful method to assist in this.