Vazquez Inelastic Mobilization System

CASE STUDY:  BB is a 20-year-old Mexican male who sustained a gasoline based 3rd degree burn to the entire dorsum of his left non-dominant hand. Full thickness skin grafts were harvested for complete skin coverage.  

Digits 2,3,4 and 5 received a continuous graft from the MPs distally; another graft segment was placed on the dorsum of the hand allowing a safe-space for MP flexion.  The thumb, however, had one graft segment from the CMC over the MPJ to the nail bed.  As healing progressed and the graft naturally contracted, the MP joint assumed a resting posture of slight hyperextension.  Composite CMC, MP and IP motion was therefore limited, due to soft tissue restriction not joint contraction. The thumb could oppose to the pulp of the third digit, but the IP was maintained in taut extension. Each joint demonstrated normal passive motion. 

A circumferential hand-based composite-flexion mobilization splint was fabricated out of 1/16” thick Reveals™ low temperature thermoplastic material.  Inelastic traction was used to increase composite flexion. The first inelastic traction line was used to pull the MP into flexion.

The ClikStrips™ lockclip was attached at the ulnar aspect of the splint base in anatomical alignment with MP flexion. After a few advancements of the ClikStrips™ Strip, the MP reached the end of its available range.  The limited length and excursion of the graft pulled the IP to 0 degrees of extension. 

 The splint with ClikStrips™ traction was worn for up to 2 hours x four times a day, at the resting end range of MP flexion. BB was instructed to check periodically for circulatory changes under the finger sling.  After two days, the MPJ allowed two comfortable advancements (1.46 m per advancement) to accommodate the new end range.  

Instead of advancing the ClikStrips™ strip on the fourth day, a second inelastic traction line was added to assist in IP flexion.   

This second traction line was formed by passing the monofilament through the lockclip, which doubled  as a pulley. 

With both inelastic traction lines in use, the ClikStrips™ strip for the MPJ was set back to the initial  progress mark. This provided the necessary slack, so that the elongated tissue could allow IP flexion.  Two lines of traction were necessary as the tissue restriction transverses two joints.                                                                                                                        

The tissues tolerated 1 to 2 ClikStrips™ advancements per week. By week 5, the thumb opposed to the pulp of the fifth digit, and BB was able to flex the IP to the base of the middle phalanx. 

Even with the limited space on this hand-based splint, the compact low-profile design of the ClikStrips™ allowed ample room for both inelastic traction lines to the MP and IP joints.



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Last modified: 06/01/03.