An Improvised Approach to Relative Motion Extension Splinting in the Emergency Room

Lacerations to the dorsum of the hand are frequently complicated by involvement of extensor tendons. Bedside repair of these injuries in the emergency room decreases time to treatment and avoids operating room expenses and anesthetic associated risks. Optimal outcomes require prompt follow-up and initiation of hand therapy to promote tendon gliding and prevent tethering of scar tissue. Here, we present our improvised relative motion extension splint utilized in treatment of zone five and six extensor tendon lacerations. This orthosis is preferred in isolated extensor tendon injuries that are amenable to primary repair at the bedside in the appropriately compliant and motivated patient. Our design is comprised of readily available supplies in the emergency room setting. Our improvised relative motion extension splint is lighter weight versus a traditional plaster orthosis and frees the patient to engage in activities of daily living with the injured hand on day four following tendon repair. With repeated application we have become facile with this design, which also permits flexibility such as placement of a wrist extension splint component if needed. Relative motion extension splinting is an established method of treatment following extensor tendon repair. Here, we present a straightforward method of fabricating such a device in the emergency room without the availability of thermoplastic materials. Future study will be needed to establish the efficacy of this device versus its thermoplastic counterpart.