Broken Hand- Splint ideas-3d printing???? HELP!!!!

LEAKYSEALS951 · 09:37 AM

I broke my hand the other week at the beach.
Basically the 5th metacarpal broke. Got operation on Friday to pin it.

Here's the bad news:

I am a dentist. This is my dominant hand. I will be in a cast for 6 weeks. I work in a public health setting. This will cost the clinic approximately 1000 patient visits and $200,000 in delivered care. As you can imagine, I am devastated.

Here's the weird thing- I broke it almost 2 weeks ago. Thinking it was only a bad sprain- I finished my week at the beach- packed the car- drove home- and worked a full week on patients before the surgery on Friday. No splint- occassional advil. Since the broken digit is effectively my pinkey finger- I was able go grasp with my thumb and four other fingers. I pulled teeth, did pretty much everything I needed to do.

Currently, the "plan" is to wear a splint for a week, then get a cast for 3 weeks, then remove the cast and the pins, and then wear another cast for 2 more weeks. This does not include recovery time.

So long as I can use my thumb and second and middle fingers- I can work, however- wearing gloves with a cast or this splint is out of the question. What I am wondering, is there a way to devise a low profile splint either custom made of fiberglass or 3D printing that would be narrow enough profile to allow me to wear gloves.

I have one week to produce such splint before the doctor puts on a real cast. Basically, the splint needs to immobilize my wrist, 4th and 5th finger and could slide in from the side and be stabilized with tape. The broken metacarpal is stabilized with 2 externally fixated pins

Is 3d printing even an option? I don't know- because my hand would have to be scanned and such. Is this even a possibility?

I am pretty bummed at the moment, but need to check all possibilities. Thanks for any advice. If it weren't a $200,000 question. I wouldn't even bother, but this really puts my clinic in trouble. Any thoughts welcome.

Thanks,
Ron

Noah930 · Noah930's Garage

Have an OT (Hand therapist) fabricate a thermoplastic ulnar gutter short arm splint? Will tie up the ring and small digits, but leave the thumb, index finger, and middle finger free. Thermoplastic can get wet. But...

Under the current splint, you've had a closed reduction and percutaneous pinning (CRPP)? So no incision, but there are two Kirchner wires protruding through the skin from the 5th metacarpal head? Or have the wires been buried under the skin? That makes a difference--though it sounds like you've got exposed hardware.

What's the Date of Injury? What's the Date of Surgery? This type of injury usually takes about 6 weeks to heal. If things go well and you take it easy, you can be out of immobilization after about 4 weeks.

Any x-rays to share?

Dantilla · 09-20-2015, 09:58 AM

Quote:

Originally Posted by Noah930

Have an OT (Hand therapist) fabricate a thermoplastic ulnar gutter short arm splint?

Is this the plastic stuff that gets moldable when placed in boiling water? Good stuff, very thin. Trim to fit with big scissors.

I had a similar break, similar splint. Everybody said I'd have surgery except the hand surgeon. Just immobilized for a few weeks. Still bothers me sometimes.
I've been told it's nerve damage. While only one bone broke, every joint in the hand took a very hard hit.

stomachmonkey · 09-20-2015, 10:24 AM

Sorry to hear.

Not much help to you now but back in the day when my income was tied to the use of my hands I took out an insurance policy.

Hope you figure something out.

Noah930 · Noah930's Garage

Quote:

Originally Posted by Dantilla

Is this the plastic stuff that gets moldable when placed in boiling water? Good stuff, very thin. Trim to fit with big scissors..

Exactly. A physical therapist is not likely to be able to make one--better bet is a hand therapist/occupational therapist.

craigster59 · craigster59's Garage

You can ordr materials here and make your own. The stuff is called Rolyan, you can buy kits or "roll your own"... Patterson Medical - Splinting

LEAKYSEALS951 · 09-20-2015, 02:38 PM

Quote:

Originally Posted by Noah930

Have an OT (Hand therapist) fabricate a thermoplastic ulnar gutter short arm splint? Will tie up the ring and small digits, but leave the thumb, index finger, and middle finger free. Thermoplastic can get wet. But...

Under the current splint, you've had a closed reduction and percutaneous pinning (CRPP)? So no incision, but there are two Kirchner wires protruding through the skin from the 5th metacarpal head? Or have the wires been buried under the skin? That makes a difference--though it sounds like you've got exposed hardware.

What's the Date of Injury? What's the Date of Surgery? This type of injury usually takes about 6 weeks to heal. If things go well and you take it easy, you can be out of immobilization after about 4 weeks.

Any x-rays to share?

Thanks everyone. As usual PPOT has an answer to everything. This gives me some direction. -I broke it on 9/8 ( a monday). I was hoping for a bad sprain- It was swollen and bruised, but symmetrical, and I could pull on my pinky finger and manipulate my hand in ways that were inconceviable if it was broken. Since I was out of town- I opted to hope for bad sprain and finished up the week on occassional advil. Back in my office next monday, I took my own dental radiograph- which showed an oblique fracture with some shortening/ displacement of the bone. My stomach turned. That monday I got worked into the MD's office, and operated on 9/18.

The MD mentioned the percutaneous pinning, but made no mention of the wires. Unfortunately, I have no radiographs (pre or post op). Since I was effectively a work in, I have tried to be brief in my dealings with the MD. I might try to get those this week and will discuss thermoplastic options with the MD. My next meeting with him is this coming 'Friday and I would like to have my ducks in a row to achieve good immobilization without completely closing the clinic- although I don't know how to effectively say "hey my porsche site said one month!!!"

It still blows me away how much I did with it broken- carrying my daughter, drilling on teeth- grabbing forceps and pulling teeth. It really is a interesting fracture being on such a low force area of the hand. I was getting a little pi$$y by the end of the week- but pretty much pulled it off with 800mg advil once or twice daily. Please keep the advice coming though- I will go stir crazy being out of work for so long- and NOT being able to do things around the house-(yardwork, guitars, chainsaw work, cars, home repair, etc...)
Thanks again, Ron

aigel · aigel's Garage

I would take the time off for proper recovery and not continue to work on something that is broken. Rest has to be a big aspect in healing properly. I'd rather rest now and give me the best chance for 100% recovery.

You know, we all feel that our work is super important and the place will go under without us. Experience shows that this is not the case. If they know you are out for 2 months, they can get others to work overtime, get a temp person etc. etc. I have seen people suddenly resign, die, get fired etc. and they thought the company would not survive without them. Sure it did. Nobody is irreplaceable. Keep this in mind before jeopardizing your recovery.

I know, probably not what you asked for.

G

Noah930 · Noah930's Garage

Percutaneous pinning is usually done with Kirchner wires (K-wires). Do the ends of the wires stick out from the skin? Or are they buried subcutaneously?

LEAKYSEALS951 · 04:02 PM

^I will need to find out. It was described to me as 2 screws in an "x" pattern with heads protruding out of the skin to get access for removal- but now that you mention it, the wire makes more sense. I will find out if the ends are submerged or not
Also- thanks Aigel. I understand pushing things too soon and that's the last thing I want. If anything, this would have me returning in limited capacity for exams/ easier procedures/ working predominantly right handed. We are working to get a retired dentist signed up for insurance to have him help. Anything I can do to help out, and not lose too much strength in my hand (on the good digits) while not jeopardizing the broken bone's healing is what I am after. If I can get on a glove, and hold a mirror-that would be good.

Believe me- the "anyone can be replaced" feeling sickens me right now. Not just from a "I'm going to be gone for 2 months" scenario, but from a "It didn't heal right/ and/or/ you cant pull your weight while/after healing standpoint"

If there is any consolation in that aspect, upon learning my fate I told my boss immediately I understood if he needed to replace me, to which he replied "Yeah- well that might be a short term solution, but cause more problems in the long term." so that was slightly comforting- sort of, but not really.
Even before this- I am a perpetual worrier and could probably tie this into the "panic attacks" thread pretty easily 100x over.
either way- not fun stuff!

Thanks,
Ron

Noah930 · Noah930's Garage

You are not going to be able to get an exam glove on while those pins are there. Those pins can come out about 4-6 weeks after the surgery.

Pins, wires: those terms are used interchangeably.

gt350mike · 09-21-2015, 07:46 PM

I just went through the same scenario starting around 21 Aug. I broke my metacarpal on my right hand and thought it was a bad sprain until the swelling went done several days later. I had some discomfort but nothing a few ibuprofen wouldn't take care of. Fast-forward to today (3 weeks after surgery), I'm still wearing a cast protecting two pins (potruding out......not for the faint of heart like myself) that won't be removed for another 2 weeks. I don't have any guidance on this (I'm the last person you'd want any medical advice from anyway) but I am really curious to hear more. I'll see if I can get a pic or two of the x-ray and post it later.

HHI944 · 09-21-2015, 08:22 PM

You guys got casts?
I had a left Bennet's Fracture years ago with 6mm subluxation. My Surgeon wanted to try closed reduction first. Woke up with 2 pins and no cast. He said "Don't bump it into anything, but if you do, you won't do it more than once" He was right about that.
4 Week mark came and he broke out the pliers to remove the pins. One came out without a problem, the other was so stuck that I vomited from the pain. He scheduled surgery to remove. He said it took him and the anesthesiologist (both big guys) both pulling like hell to get it out.

Kraftwerk · 09-22-2015, 08:22 AM

Hello Doc. Join the club .. ! I broke my 5th meta carpal on June 29 and it is already 99% healed or even 100%.. You have to go with the thermoplastic ulnar gutter short arm splint..Its removable to swim , shower , take hot tub etc. I am surprise you are getting it pinned and operated on. Mine was set ( externally ) no invasive surgery or cutting of flesh.. I can see that recover taking much much longer. This particular brake is super-common and should be externally settable. Since it's 'just' your pinky, you will be able to use your hand & the other fingers. The fact that you are a dentist, well like a classical musician, artist, etc, you depend on your hands for income. Might be a good time to ask an old Med-school chum to fill in and take some extra work at your clinic so your other employees still get paid. Not sure how those things work. I lost a lot of work when my hand was 'tied' up.. you gotta take the good w/ the bad in this life. Speedy recovery!

Dantilla · 09-22-2015, 10:01 AM

The other thing that surprised me- After not using the hand, therefore arm, for weeks, the amount of strength lost was a shock.

Popped a wheel/tire off the Jeep to inspect the brakes, and really struggled to get it back on. Sure, it's a heavy, tall, wide knobby off-road tire, but it had never been hard to lift a few inches onto the lugs.

Took quite a while to build the strength back. I mounted a pull-up bar in the garage to help.

gt350mike · 09-23-2015, 07:06 PM

Only 10 more days before the pins are removed.

LEAKYSEALS951 · 09-24-2015, 10:25 AM

Hello folks- Update!
Got the thermoplastic gutter cast today. Based on the fixation- the doctor even made it a hand cast. Thanks to everyone- especially Noah930- who's recommendation changed my Doc's plan in the 11th hour from a fixed cast to a trip over to OT for the custom splint- here are the pics of the cast (I didn't want to hassle the doc over radiographs)- what a difference!
PELICAN PARTS BRAIN TRUST IS AWESOME!!!!!!!!!!!!!!

Immediately post op:

This morning (actually making FACEBOOK thumbs up gesture I'm so happy- and I'm no zuckerburger fan!)

Without this thread- that would have been a big honkin' cast on there!
Thanks again!