Splints and Bracing of the Elbow

Introduction

Splints are frequently employed at the elbow to provide both static and dynamic protection and to deliver flexion or extension torque. The four most common clinical applications for braces or splints in both postoperative and postinjury management include resting and hinged splints, and dynamic and static adjustable splints.

A simple classification of elbow splints that follows the clinical application has recently been proposed: (1) immobilization, (2) restrictive (protective), and (3) mobilization—to gain motion: dynamic or static adjustable.

Static and Protective Splints

Immobilization bracing is occasionally employed at the elbow, to rest the soft tissues or to avoid an extreme position of elbow extension. Previously, resting splints were most commonly used in those with rheumatoid arthritis. Because of the effectiveness of disease-remitting agents, this type of splinting is uncommonly indicated today ( Fig. 16.1 ).

For the unstable elbow a hinged splint is used ( Fig. 16.2 ). By initially locking the hinge (restrictive bracing), the same device can be used as a resting static splint; some designs allow conversion to a movable stabilizing device. Hinged splints allow active motion and are employed primarily to protect against varus and valgus stress during ligament healing.

Elbow Stiffness

The most common complication of elbow injury, and even in some arthritic conditions, is stiffness. The most important means of avoiding this after a fracture or dislocation is rigid fixation accompanied by early motion of the joint (see Chapter 53 ). After fracture dislocation, it has been demonstrated that immobilization lasting for more than 4 weeks correlates to increased contracture at final follow-up. Despite the recognized value of early motion after injury or surgery, stiffness of the elbow remains a common problem in orthopedic practice. Unfortunately, in the author's experience, the use of aggressive physical therapy to address posttraumatic stiffness is not always successful and, in fact, as often as not, makes the contracture worse. Over the years there is increasing evidence of the value of “mobilization” splinting, without the adjunct use of formal physical therapy. This justifies the use of splinting in this clinical setting, but to understand the rationale of splinting for this condition, it is necessary to understand the physiology of the process.