Custom vs Pre-Fabricated Splints: Which One Is Better?

December 11th, 2019

 

If your wrist or hand has been injured or affected by a condition such as arthritis or tendinitis, you might need a splint for therapeutic reasons. However, this question will come up: selecting custom vs. pre-fabricated splints?

There are three types of splints available when working with a hand and wrist rehabilitation specialist. These are custom-fabricated, custom-fitted, and pre-fabricated.

In this article, we’ll discuss what distinguishes these types. We’ll also consider the preferences of three groups affected–doctors, hand rehabilitation specialists, and patients.

First, we need to clarify some terminology you’re likely to run across if you’re involved in rehab for hands and wrists.

Terminology

Medicare and Medicaid have recently revised the language used by doctors and therapists specializing in injuries or diseases that affect the hands and upper bodily extremities.

Specifically, what used to be referred to generically as “splints” are now called “orthosis.” “Orthotics” refers to the science of fabricating or fitting orthoses–which is our primary focus here.

“Splints” now refers to casts and strapping material used to reduce fractures and dislocations. Here, we’ll stick with the more familiar term “splint” for those still learning the new terminology.

Two or Three Types of Splints

Some say there are two types. Others say there are three.

Custom-Made

A custom-fabricated splint is one produced to fit, and address the issue concerning, a specific patient. Fabrication begins with the patient’s hand being traced on paper. Then, the outlined hand is cut out.

This is used for cutting the fabrication material (typically one of several low-temperature thermoplastics). Next, the cut-out material is heated in a water bath, removed, and fitted directly on the patient’s hand.

The advantages of custom-fabricated splints include:

• A near-perfect fit.
• The ability to be adjusted.
• Being specific to the individual patient and her condition.
• Plus, they’re easy to wash with soap and water.

The disadvantages include:

• The splint easily melting when exposed to higher temperatures (e.g., when cooking).
• The Velcro fastenings getting lost.

Not a bad balance, all things considered.

Pre-Fabricated (“Soft”)

In contrast, a pre-fabricated splint is one that is manufactured in quantity and meant to fit virtually anyone. It can be purchased without a prescription and is easy to replace when damaged or worn out.

It’s also more durable and is made with breathable fabric. Plus, while not as easy to wash as the custom-made splint, it is hand-washable.

Custom-Fitted

This is a hybrid of the two typed just discussed. The splint itself is pre-fabricated but requires adjusting by a doctor or therapist.

Research Studies

We reviewed some academic research on splints used for two common conditions: carpal tunnel syndrome and osteoarthritis of the first carpometacarpal joint (the joint at the base of the thumb).

Study 1: Osteoarthritis of the First Carpometacarpal Joint

A 2018 meta-analysis (a statistical analysis of previous studies) compared prefabricated soft splints with short thermoplastic custom-made splints. These are the most commonly used for osteoarthritis of the first carpometacarpal joint (CMC OA).

This research reflects the results of five randomized clinical trials with 230 patients with an average age of 61. The findings showed that “both thumb-based splints improved pain and function in the first CMC OA in a short-term follow-up.”

The ability of prefabricated splints to ease the condition was higher than with custom-made splints. Meanwhile, the findings related to pain, grip and pinch strength showed identical improvement after wearing either type of splint.

This study reveals more than most since it reflects the results of five earlier studies that address the same research problem.

Study 2: Why Many Patients Prefer Pre-Fabricated Splints

This 2014 experiment asked whether “the use of orthosis affects grip strength in persons with carpal tunnel syndrome (CTS) in a way that supports preference for custom-made orthoses with neutral wrist position over prefabricated orthoses.”

The study sample comprised 20 patients at a clinic in Slovenia. Participants were between ages 18-80 and had been diagnosed as having CTS in one hand. They were either candidates for orthotic treatment or had rejected surgery.

A significant component of CTS therapy is the ability of a splint (orthosis) to maintain the wrist at a certain angle. It was hypothesized that a custom-made splint would do this more effectively than a pre-fabricated splint.

This turned out not to be the case, though. The results showed that neither the pre-fabricated orthoses nor those that were custom-made had any effect on grip strength in either the affected or the non-affected hand. Both hands were studied.

It was noted that along with the smaller sample, a limitation of the study was that  measurements were not repeated after a defined period of wear. Researchers also did not test for repeatability of the method.

Still, the studies raise important questions.

What Does All This Mean?

It’s clear that more research on this topic is needed. We did a review of study abstracts using Google Scholar. It suggested that other researchers have been getting different findings. It’s possible that some conflict with the studies we’ve discussed.

The two studies discussed above are not enough to reveal much. For now, though, it sounds as though all the options currently available for hand and wrist splints are at least viable ones.

Some questions that need to be considered in future studies might include the following:

• Ways to ensure patient compliance–that is, how you can be sure all patients actually used the splints as prescribed or as often as prescribed.
• Ways to gather a sufficient sample size
• Qualitative research to learn about patients’ experiences using the splints
• Qualitative research to learn why medical providers prefer custom-made splints. It should show as well how they share those reasons with patients
• Considering a greater variety of conditions needing hand-splint treatment

We’re sure to think of more soon!

A Bit of Subjective Follow-Up

We have acquaintances who have worn both custom-made and prefabricated splints for both CMC OA and CTS. They see both sides of this continuing debate. The custom-made splint, worn for CTS only, kept the wrist well positioned and comfortable during sleep.

They admit, though, it was inconvenient to wear this during the day. They far prefer the pre-fabricated splint they’re now wearing for CMC OA. It’s more convenient and comfortable, they say–for the reasons indicated above.

They (like many of us) probably need to understand better why medical providers prefer custom-made splints. These professionals have seen far more patients and far more outcomes than our few acquaintances have.

That reminds us… if you live in or near NYC and are experiencing hand difficulties, please reach out to us. We’d be more than happy to help!