Objective: As the number of recent publications show, mobilization splinting of wrist and elbow throws a challenge to hand therapists. The number of existing designs is confusing. The purpose of this study is to present a simple and efficient solution to improve ROM based on revisited metal frame, easy to custom make, “lively splint” technology. Biomechanics: All movements are diagonal and spiral in character due to joint anatomy and diagonal orientation. For instance, dart throwing motion starting from wrist extension, radial deviation, and supination leads the wrist into flexion, ulnar deviation, and pronation. Elbow extension brings the forearm from a flexed and varus position to extension and valgus. During flexion and extension, physiological joint axis move. Full finger, wrist, and elbow flexion shortens the anterior anatomical structures while lengthening the posterior one and reciprocally for extension. Fixed axis hinged splints cannot follow the physiological joint axis displacement nor can shorten or lengthen to accommodate anatomical modifications. Fixed axis hinged splint cannot allow full flexion and extension and actually prevent it. Joints and soft tissues have to adapt to the 1-plane movement allowed by fixed axis splints, because these splints do not adapt to physiological movement. Materials and Methods: After the work of Capener and Whynn Parry, metal frame splints also known as “lively splints” were very popular in the 1950s and 1960s. With the advent of thermoplastic, they fell somehow in disgrace. However, modernized by adding proximal and distal cuffs swiveling on the frame, counter pressure cuff made of conforming material like leather to exert a perpendicular force whatever the limb position, the concept of metal frame acting as a “chassis” as well as a “motor” located on either side of the anatomical segment represent the ultimate low profile and are user’s friendly. They allow diagonal movements and some rotation and can follow the shortening or lengthening of anatomical structures during flexion and extension. They act as a 3-point splint, as a double lever of the second order, the most efficient mode of improving ROM. According to Paul Brand’s work, serial static splinting is the most efficient technique followed by progressive static splinting. However, serial static splinting using plaster of Paris or thermoplastic is time consuming since it requires at each increase in range of motion making a new cast or reheating and remodeling the thermoplastic splint. Conclusions: Metal frame splinting can act either on the progressive static or dynamic mode if coils are built into the frame. They are made once for all and are easy and fast to adjust. Thanks to adapted tools they are also easy to make and inexpensive.
