Abstract:
An orthopaedic splint apparatus and technique involving the use of a water hardenable blank with (1) primary tacking arrangements for adjustably holding the splint or support in place after it has been activated and placed on the injured part of the anatomy, and may also include (2) secondary, functional arrangements for holding the splint firmly in place following accurate mounting and location of the splint on the injured part of the anatomy. The tacking arrangements may involve the use of lateral extensions from the main body of the splint with hook and loop type fasteners or adhesive associated with the extensions for holding the splint onto the injured part of the anatomy.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     This is a continuation-in-part application of co-pending parent application Ser. No. 10/828,744, filed Apr. 20, 2004, whose entire contents are hereby incorporated by reference. 
     
    
     BACKGROUND OF THE INVENTION  
       [0002]     This invention relates to orthopaedic splints or supports.  
         [0003]     In the field of hardenable orthopaedic splints and supports, the splints are normally rectangular in shape and are held on to the anatomy by a finishing tape of some kind wrapped along the entire length of the splint. To function properly, both the splint and finishing tape are soft and supple in order to conform to the contours of the anatomy. During application of the splint, it is necessary that the limb be held in a variety of positions. Frequently, lengthy splints must be used to properly immobilize the injured limb, and gravity causes one end or the other of the splint to fall away from the anatomy or merely shift away from the proper position. If one person is attempting to apply the splint, it is difficult to maintain the appropriate position for each particular injury during application. Usually it is necessary to ask for additional assistance to ensure proper application. More particularly, an extra set of hands is required to keep the splint in the desired location on the patient&#39;s anatomy until the outer securing or immobilization means has been applied.  
       SUMMARY OF THE INVENTION  
       [0004]     In accordance with the present invention a splint, blank, or main support is provided with primary tacking arrangements to help hold the splint, blank, or main support in place, allowing the physician or technician the use of two free hands for quickly and easily adjusting the position of the splint, blank, or main support if necessary without removing or loosening the primary tacking arrangements. The physician or technician then applies a secondary, more supportive securing arrangements to effectively hold the splint, blank, or main support to the injured part of the patient&#39;s anatomy.  
         [0005]     In accordance with one illustrative implementation of the invention, the primary tacking arrangements may include mating hook and loop type material such as VELCRO® type inserts or pads, or hook type patches used with a splint covering of unbroken loop (UBL) or other hook receivable material on the surface of the splint. In this regard the entire hook receivable surface acts as the loop portion of the hook and loop fastening arrangements.  
         [0006]     In addition, with the splint or support normally being longitudinal in extent, laterally extending securing extensions may be provided with hook and loop, adhesive or other securing arrangements at the outer ends thereof. These lateral extensions may be formed as part of the hardenable portion of the splint, or as part of one layer thereof, or may be separate straps or the like, secured to the splint blank.  
         [0007]     The secondary or “functional” securing arrangements may be in the form of a stretchable wrap such as an ACE® bandage, or may be straps, where the said arrangements are of sufficient strength to firmly hold the splint to the injured part of the anatomy during regular usage for extended periods of time.  
         [0008]     Other features which may be included in implementation of the invention may involve the following:  
         [0009]     1. The use of “spacer” type double knit material for the splint.  
         [0010]     2. The use of an outer or secondary support such as an exo-skeleton type support, with associated straps serving as the functional securing arrangements.  
         [0011]     3. The use of non-rectangular splints, with laterally extending areas forming the primary securing arrangements.  
         [0012]     4. The use of a roll of splinting material, with lateral extensions spaced along its length.  
         [0013]     5. The use of splint blanks with a thumbhole or another web space locater forming a part of the assembly.  
         [0014]     In the field of splinting it is normally desirable to fully secure the splint or cast so that it will not come off or shift location during the normal course of daily activities. The primary holding or splint locating arrangements in the present invention are used when the splint blank is flexible and is being initially applied. These primary securing arrangements may be considered to be temporary “tacking” or locating arrangements, as they permit easy adjustment of the splint position, and are usually of insufficient strength to rigidly immobilize the splint for long term use by the patient.  
         [0015]     Accordingly, when the term “tacking” is used in the present specification and claims, reference is being made to the primary holding arrangements which are of insufficient strength to fully secure the splint; and subsequent securing arrangements are normally required in addition to the “tacking.” The “tacking” may be implemented, for example, by hook and loop fastening arrangements, by adhesive, by snaps, by hooks or any other suitable arrangement; and functional securing of the splint may be accomplished by lamination of the layers when the edges of hardenable material are overlapped, by wrapping with flexible tape, such as an ACE® bandage tape, by straps, or by any other securing arrangement of sufficient strength to properly immobilize the splint to the injured portion of the anatomy.  
         [0016]     It is further noted that the use of a layer of UBL or hook-receivable material has the additional advantage of restricting the flow of the hardenable material, as set forth in, for example, U.S. Pat. No. 6,824,522 (Henderson, et al.), titled “Hardenable Orthopaedic Supports,” whose entire contents are hereby incorporated by reference.  
         [0017]     In accordance with a method illustrating certain aspects of the invention, a splint or support is formed with sheet material impregnated with hardenable material, and with one or more primary laterally extending tacking extensions. The hardenable material is activated and the splint or support is held to the anatomy by engaging the laterally extending extensions; and the position and/or configuration of the impregnated sheet material is adjusted prior to the hardening of the hardenable sheet material while it is being loosely held by the tacking extensions; and the adjusted position is maintained while the hardening is accomplished.  
         [0018]     Other objects, features and advantages will become apparent from a consideration of the following detailed description and the accompanying drawings. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0019]      FIG. 1  is perspective view of a short arm splint embodiment illustrating the principles of the invention;  
         [0020]      FIG. 2  is a partial cross-sectional view of part of the assembly of  FIG. 1  prior to application;  
         [0021]      FIG. 3  shows a splint roll with laterally extending tacking arrangements;  
         [0022]      FIG. 4  shows a longitudinally extending splint or support blank with tacking arrangements extending from one side thereof;  
         [0023]      FIG. 5  illustrates a splint blank with shaped tacking arrangements extending from both sides thereof;  
         [0024]      FIG. 6  shows a non-rectangular splint or support blank with laterally extending tacking arrangements;  
         [0025]      FIG. 7  is a showing of a splint blank with thumb holes within the laterally extending tacking arrangements;  
         [0026]      FIGS. 8 and 9  are perspective and cross-sectional views, respectively, of another embodiment of the invention;  
         [0027]      FIG. 10  shows a splint or support, and an outer exo-skeletal construction;  
         [0028]      FIG. 11  illustrates a splint or support for the forearm and thumb, with an attachment extending through the web space between the thumb and forefinger; and  
         [0029]      FIG. 12  shows a splint for the upper and lower arm with an “anti-flexion” strap.  
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0030]     While the specification describes particular embodiments of the present invention, those of ordinary skill can devise variations of the present invention without departing from the inventive concept.  
         [0031]     Referring more particularly to the drawings,  FIG. 1  shows a splint or brace  12  mounted on the forearm  14  of a patient. The main part of the brace  12  is optionally folded over at reference numeral  16  at the palm of the patient&#39;s hand, and strap  18  extends over the back of the hand. The straps  18 ,  20  and  22  are secured to or are part of the main part  24  of the splint, and are provided with hook type fastener  26  on the underside of straps  18 ,  20  and  22  as shown in  FIG. 1 . The areas of the splint  12  underlying patches  26  are of hook receivable type material, so the straps  18 ,  20  and  22  are held or “tacked” in place as the splint  12  is applied. With the splint being held onto the forearm in an adjustable manner, the physician or medical technician can readily position the splint to the precise desired location, without the assistance of additional medical personnel.  
         [0032]     The splint location is subsequently immobilized by wrapping the flexible, resilient tape  30  around the forearm and splint. This tape  30  may be of the type sold under the ACE® trademark.  
         [0033]     In various embodiments, relative to the hook receivable type material underlying the hook type patches  26 , it may either be in the form of hook receivable type patches secured to the splint  12  in selected areas; or alternatively, the entire splint may be covered with a layer of unbroken loop (UBL) or other hook receivable material, so that the hook type patches will engage and secure to the splint  24  at any convenient location.  
         [0034]     Furthermore, instead of VELCRO® type fasteners, adhesive, snaps, or hooks, for example, could be employed for tacking the straps  18 ,  20  and  22  in place.  FIG. 2  is a schematic cross-sectional view of a part of the assembly of  FIG. 1  prior to application. In  FIG. 2 , the main portion  24  of the splint  12  includes an inner padding layer  40 , and a central layer of hardenable material  42  preferably made of a double knit spacer material. The double knit spacer material includes upper and lower woven or knit layers, with an integral matrix of fibers or filaments interconnecting the upper and lower layers. Such double knit materials are disclosed in, for example, U.S. Pat. No. 6,139,513 (Grim, et al.), whose entire contents are hereby incorporated by reference. An additional layer of unbroken loop (UBL) or hook receivable material  44  is adjacent to the upper surface of the spacer material  42 . The strap  20  may be formed of separate material, or may be a continuation of any one of the layers of the main body  24  of the splint blank. It may also be either permanently attached or removably attached, using VELCRO®, hooks, etc. At the outer end of strap  20  is a patch  26  of hook type material for securing to underlying hook receivable type material  44 .  
         [0035]     The hardenable layer  42  is preferably impregnated with a water activatable material such as urethane. The layer of hook receivable or UBL material  44  may inhibit the transfer of the water activatable material to the outer surface of the splint.  
         [0036]      FIG. 3  shows a continuous roll of a splinting material  52  with laterally outwardly extending tacking arrangements  54  having patches  56  of hook type material located at the ends thereof. The main body of the splint roll  52  consists of at least one layer of material impregnated with a water activatable material. The outer surface of the splint roll  52  may be covered with hook receivable material or may be provided with patches of hook receivable type material for tacking engagement with the hook type patches  56 . The tacking strips  54  may be in the form of separate strips with hook type patches  55  at the inner ends of strips  54  as well as on the outer ends of strips  54  where hook type patches  56  are provided. This gives flexibility in the location of the tacking arrangements of the splint onto the anatomy. Alternatively, the tacking strips  54  may be permanently secured to the splinting material  52  or the strips  54  may be an extension or continuation of one of the layers of splinting material  52 . A splint or support may be cut from the roll at any desired length to form a blank of the desired size.  
         [0037]     The preferred splint roll configuration is an inner activatable material of at least one layer with an outer covering material on one side and a padding layer on the other. The outer covering is preferably made from a hook receivable material, such as a UBL material, and the padding may consist of at least one layer of either a double knit spacer material, foam, or a nonwoven material. Throughout the length of the splint are tacking arrangements spaced at equal intervals. The extensions may have hook type arrangements on both ends so that they would be removable and movable with respect to the splint assembly. It is also preferable that the tacking arrangements be made of a stretchable material and have a configuration that would ensure proper securing yet not cause any discomfort to the end user. An acceptable material to use would be a nonwoven because of its cost effectiveness and low profile. The splint can be cut to usable lengths prior to packaging or may be provided in long lengths and may be cut to the appropriate size immediately prior to application.  
         [0038]     In the case of all of the embodiments as disclosed in this specification, the construction and alternatives as disclosed herein may be used in each of the constructions intended for specific application. Thus, for example, after cutting off a length of the splint roll  52 , activating it, and tacking it in place, the splint may be wrapped with a flexible wrap, to functionally secure the splint.  
         [0039]      FIGS. 4 through 7  show further embodiments of the invention with different geometric configurations. In  FIG. 4  the longitudinally extending main blank  60  has laterally extending tacking arrangements  62  extending from one side. Hook type patches  64  are provided at the outer ends of the tacking extensions  62 , to mate with underlying hook receivable type material. In use, these extensions  62  are wrapped around the anatomy and secured to either the outer hook receivable covering of the splint  60  or to strategic areas where hook receivable patches have been placed on the surface of the blank  60 . The lateral extensions may be an extension of the covering material, padding material, hardenable material, or may be made from an entirely separate material attached to the splinting assembly. The extensions may also be either permanently attached to the splint, i.e., by sewing, or may be removably attached using arrangements such as a hook type fastener.  
         [0040]     In  FIG. 5  the main longitudinally extending splint blank  72  has shaped laterally extending tacking arrangements  74  with hook type patches  76 . In this particular example, the shaped tacking arrangements are staggered and sufficiently wide to allow for complete coverage of the arm when in use, giving circumferential compression and a broader distribution of the forces exerted by the arrangements than would be provided by a narrower strip.  
         [0041]     In  FIG. 6  the hardenable portion of the splint blank  78  has a “snowman” like configuration, with rounded lateral zones  80 . The rounded or contoured shape of the hardenable blank can be strategically designed to better fit and mold to the complex contours of the anatomy than a rectangular splint with no contours. To these lateral zones  80  are secured laterally outwardly extending tacking extensions  82  with mating hook patches  84  and hook receivable patches (or a UBL layer) underlying these extensions when the splint is applied. Instead of having one set of extensions as in  FIG. 5 ,  FIG. 6  shows two sets of extensions which will both wrap partially around the anatomy and mate with each other to provide the tacking arrangements.  
         [0042]     The splint blank of  FIG. 7  has a longitudinally extending central zone  88  and shaped laterally extending zones  90  and  91 . Having shaped extensions instead of rectangular strips provides for wider coverage and more pressure distribution over the strapping area, thus reducing potential pressure points associated with a thinner strip. The laterally extending zones  90  have hook type patches  92  to engage mating hook receivable type material  93  on the paired zones  91  on the other side of the blank  88 . Alternatively, the entire surface of zones  90  and  91  may be of a hook receivable material and thus the patches  93  would be unnecessary. In use, the thumb is slid through one of the pre-made thumb holes  94  which provide assistance in locating the blank  88  on the forearm of the patient. Multiple thumb holes are provided so that application is possible, regardless of the initial orientation of the splint when removed from the package. Other methods of creating a thumb hole include providing slits in the zones  90  and  91  or making the laterally extending zones out of a tearable material which can be torn to receive a thumb in the appropriate location immediately prior to application.  
         [0043]     Referring now to  FIGS. 8 and 9  of the drawings,  FIG. 8  is a perspective view of a water hardenable splint or support in roll form; and  FIG. 9  is a cross-sectional view taken along the plane indicated at  9 - 9  in  FIG. 8 . In  FIG. 8 , the roll  172  is partially unrolled to show a section  174  which may be cut off at the desired length.  
         [0044]     As shown to advantage in  FIG. 9  the splint or support may have a base  176  of spacer material impregnated with water hardenable material. Extending along and secured to one edge  177  of the base  176  is a strip of folded sheet material  178  which has hook material  180  located on one surface thereof as indicated in  FIG. 9 . From the other edge  182  of the base  176 , a second folded strip  184  is secured. The strip  184  may be formed of hook receivable sheet material, such as UBL material or a non-woven fabric.  
         [0045]     Shown in dashed lines are the strips  178 ′ and  184 ′ in an unfolded configuration, to extend around a portion of the anatomy such as a forearm or lower leg, for example. The hook material  180 ′ engages the lower surface of the unfolded hook receivable strip  184 ′ to hold the base member  176  onto the desired part of the anatomy. This arrangement permits tacking of the base strip  176  in place while the physician or medical technician is adjusting the position of the splint or support. As shown in  FIG. 9 , the tacking arrangements extend the entire length of the splint. It is possible to cut these arrangements into any configuration that works best for the user. For example, the elongated arrangements can be slit at various locations to form more narrow straps which can be wrapped around the anatomy. It is also possible to remove any section that is unneeded by cutting or tearing.  
         [0046]     As shown in  FIG. 9 , padding material  179  may be provided underlying the strip  176  which is impregnated with hardenable material. With this arrangement, the strip of hardenable material  176  does not directly engage the patient&#39;s skin. Incidentally, instead of being formed of spacer type double knit material, the strip  176  may be formed of multiple layers of single knit material. The padding material  179  may be composed of a layer of double knit material. The strip  176  may be covered on the other side with a layer of hook receivable material  181  which may have extensions such as those shown at  178  and  184 . Thus, the material  181  may be integral with strips  178  and  184 ; or the strips  184  and  178  may be separately secured to the edges of strip  176 . Alternatively, the padding material may extend outwardly to form the securing strips  178  and  184 . The foregoing are merely examples of alternative embodiments and many different combinations are possible which incorporate the various configurations discussed above.  
         [0047]     The assembly as shown in  FIG. 8  or  9 , may subsequently be wrapped with an ACE® type strip material. Alternatively, if the patient is not active, the strips  178 ′ and  184 ′ may provide adequate strength or securing force so that additional, secondary securing arrangements are not needed.  
         [0048]     The embodiment of  FIG. 10  includes an inner blank  102  with tacking arrangements  104  which engage the underlying opposing edge of inner blank  102 . A pre-shaped outer external wrap can serve as the functional securing arrangements. For example,  FIG. 10  is one specific example of these arrangements where exo-skeletal members  106  and  106 ′ are formed of fairly stiff plastic and are molded to the flexible material  108  which extends around and over the inner splint  102 . The plastic strip  106 ′ is molded to the flexible material  108  at the edge of material  108  away from exo-skeletal member  106 . During application, the functional securing straps  110  extend through loops  112  and are then folded back upon themselves and secured in place by mating hook and loop securing surfaces  114  on the outer ends of straps  110 . The outer exo-skeletal member is further immobilized by the attachment  116  extending through the web space between the thumb and forefinger. The attachment  116  may be secured to member  106  by the rivet  117  and an equivalent rivet (not shown) on the opposite side, or may be adjustably secured using hook and loop type fasteners.  
         [0049]      FIG. 11  shows a water hardenable splint blank  120  for providing splinting for the wrist and forearm  122 . The blank  120  is provided with an attachment  124  for extending through the web space between the thumb and the forefinger. Preconnecting the attachment  124  to span the web allows for much easier and intuitive application of the support. The attachment or strap  124  may be riveted or sewn, for example, to splint blank  120 . The attachment  124  can be made from a thermoplastic, fabric, fiberglass, or combination of these materials, for example. It is also possible for the attachment to be made from a material which has been treated to be water activatable, or alternatively may be inactivatable and remain soft and flexible for increased comfort during wear. This attachment may be permanently or removably attached and may have adjustment means, for example, hook and loop type fasteners, to accommodate different sizes of anatomy. In addition, the tacking strap  126  having a patch of hook type material thereon, engages the hook receivable type patch  128  to quickly hold the blank  120  in place. The flaps  130  are wrapped around the thumb  132  to complete the splinting of the forearm and thumb, and may incorporate hook and loop type fasteners for quick securing during application. Functional securing in this select area is then achieved by the lamination of the layers of overlapping activatable flaps  130 .  
         [0050]      FIG. 12  shows a further embodiment illustrating the principles of the invention. In this embodiment, the splint  142  is mounted on the patient&#39;s arm  144 . The tacking arrangements  146  and  148  are secured to the splint  150  at the rear of the splint. These securing points are not visible in  FIG. 12  as they are on the opposite side of the arm. The tacking arrangements  146  and  148  have hook type patches  152  and  154  mounted on the ends thereof, which mate with a complementary hook receivable type material on the splint. This loop type material may be in the form of a patch on the splint  142 , or the entire body  150  of splint  142  may have an outer layer of UBL or other hook receivable material thereon with which the hook type patches  152  and  154  engage and mate.  
         [0051]     With the outer surface being covered with a UBL or other hook receivable material, an anti-flexing strap  158  may be utilized. The anti-flexing strap  158  may have hook type patches  160  and  162  at its ends, to mate with hook receivable type material on the body  150  of the splint. During application, the anti-flexing strap  158  aids in securing the arm and limiting the ability of the arm and splint to flex until it has hardened. After hardening, it will help reinforce the splint and keep the elbow at a ninety degree angle. If desired, the anti-flexion strap  158  may be permanently secured to splint  150  at one end thereof. As shown, the anti-flexion strap is used to help stabilize an elbow. However, it may also be used to stabilize other necessary portions of the anatomy such as the ankle.  
         [0052]     An additional feature shown in  FIG. 12  is the ability to create slits  163  on both sides of the entire length of the splint. The slits allow for the splint to contour around complex curves of the anatomy without bunching and wrinkling. As shown in  FIG. 12  when the splint is molded around the elbow, the splint material adjacent the slits overlap in the area  164  forming a lower profile splint with fewer wrinkles which might otherwise cause the user discomfort.  
         [0053]     After the splint  142  is properly mounted in place, the entire splint assembly may be wrapped with a secondary, flexible, resilient tape such as an ACE® type wrap, to functionally secure the splinting arrangements.  
         [0054]     In regard to the materials used for fabricating the various layers of the above mentioned splinting assemblies, the primary tacking arrangements are preferably made from a nonwoven material. Nonwoven materials are typically very inexpensive and may be made to be hydrophobic which is very advantageous. The tacking materials may also be made of a knitted material, woven fabric, or foam. It is also beneficial if the primary tacking arrangements are low profile, stretchable and tearable. The activatable layer can be composed of a double knit spacer material, multiple layers of a single knit material, foam laminate, nonwoven material, woven material, or any suitable material that will achieve sufficient strength upon hardening.  
         [0055]     As seen in the exemplary embodiments of  FIGS. 1-3 , there is a main support body  24  that may be at least partially impregnated with an activatable and/or hardenable resin. The process of applying the main support body or splint  24  or  52  to a portion of a patient&#39;s anatomy such as the forearm in  FIG. 1  is simplified by the use of the primary holding or tacking material  20  or  54 . In various preferred embodiments, the primary holding or tacking material is made from a thin material of a thickness ranging from about 0.005-0.03 inch and more preferably about 0.01 inch thick to ensure a low profile and minimal bulk.  
         [0056]     The primary holding material should preferably be made from a material that is porous to ambient air so that it is breathable and thus comfortable to the patient. To achieve a good balance of air porosity versus hold strength and fabric integrity, the density of the primary holding material preferably falls within a range of 25-110 g/m 2  and more preferably 50-65 g/m 2 , including all values at and within the specified outer limits.  
         [0057]     Further, the primary holding material may be treated to be hydrophobic, and as mentioned above, may be nonwoven to keep down expense. Specifically, the nonwoven materials are typically made from polyester, rayon, or polypropylene fabrics. Alternatively, sheets or strips of natural rubber, latex, thermoplastic rubber (TPE) such as SANTOPRENE, HYDREL, KRAYTON, or the like may be used. Most of these materials are inherently hydrophobic. In addition, the nonwoven materials can optionally be treated, for example, with Scotchguard or a Teflon coating to enhance hydrophobic properties.  
         [0058]     The primary holding material is preferably not made entirely of the aforementioned materials, but rather such materials are incorporated into the nonwoven fabric to give it stretch properties. Most stretchable nonwoven materials are not just one layer of fabric but some type of laminated structure to allow for stretchability. It is therefore preferable that the primary holding material be a laminate of stretchable nonwoven materials selected from one or any combination of the foregoing listed materials. The nonwoven material can either be stretchable throughout its entire length or only have certain sections that are stretchable and other sections that are not stretchable. A region of the primary holding material may further be stretchable in one direction yet non-stretchable in another direction, such as longitudinally versus transversely. The non-stretchable sections or regions help keep the primary holding material or strap from “necking down” when it is stretched and wrapped around the patient&#39;s anatomy. The “necking down” of the primary holding material leads to the unwanted turniquette effect.  
         [0059]     Exemplary width dimensions for the primary holding material ranges from about 1 inch to 6 inches wide, including all sizes therebetween. To enable tacking the primary support material to the splint support body, brace, or blank, the former may be made from hook receivable material, UBL, or napped fabric, or include patches of the hook or loop portion from a hook and loop type fastener such as VELCRO®.  
         [0060]     Alternatively, a means for tacking may be used to attach the primary holding material to the splint support body, brace, or blank. For example, the means for tacking  26  shown in  FIGS. 1-2 , and items  55 ,  56  in  FIG. 3 , may be a complementary hook and loop fastener such as VELCRO®, or may be a hook receivable cover  24  seen in  FIG. 2 , or could be a weak adhesive such as that used in COBAN. A hook patch  26  on the primary holding material  20  may be used to attach the primary holding material  20  to a hook receivable or UBL cover  44  as seen in  FIG. 2 . In various embodiments, the cover  44  shown in  FIG. 2  can be a UBL or hook receivable material on the outside of the entire splint support body, brace, or blank  24 ,  52 , thus allowing the primary holding material or strap  20  to be secured anywhere thereto. Or the cover  44  may have patches of UBL or hook receivable material on the outside of the splint support body  42 , brace  24 , or blank  60 , for example. The means for tacking may itself be welded, bonded, sewn, riveted, or mechanically joined to the fabric or substrate forming the primary holding material, or it may be formed as part of the substrate or primary holding material fabric.  
         [0061]     Preferably, the primary holding material is stretchable, where its length under a tensile load L may increase up to about 50% or greater of its unstretched, initial length. This amount of stretch may be measured on the basis of the entire structure or only a portion thereof. Conventional stretchable materials used with hook and loop type fasteners can only stretch up to about 40% of its initial length. The stretching is measured from the percent of elastic increase from its unstretched, initial length, where the stretched length is achieved just prior to any plastic or permanent deformation, or failure in the material in the form of tearing.  
         [0062]     In addition, the primary holding material exhibits limited rebound, i.e., resistance to stretch. This feature prevents a turniquette effect on the wearer patient, which would otherwise impede circulation or movement of the limb, joint, or body part. Therefore, it is preferable that the primary holding material can be stretched under tensile load L to an increase in length of about 2 inches or 30% of its initial unstretched length under a tensile force of about 1.5 lbf. (6.7 N); in alternative embodiments, that tensile load L may be about 1.3 lbf. (6 N) down to 1.0 lbf. (4.5 N), or even less to achieve a 30% stretch. When the primary holding material is tested by stretching it 100% and held for about 5 minutes, the final length is about 30% or greater than the initial, unstretched length.  
         [0063]     Furthermore, the primary holding material is designed to tear before causing the turniquette effect. To achieve this behavior, the primary holding material has an ultimate tensile strength of about 10 lbf. (44.5 N) or less (but greater than 0 lbf., of course), and more preferably of about 3 lbf. (13.4 N), including all values therebetween, when tearing is initiated. The primary holding material can resist complete detachment or separation into two discrete pieces from the tensile loads L that are less than about 10 lbf. (44 N) and more preferably about 3 lbf. (13.4 N). In addition, the tearing when the ultimate tensile strength is exceeded may be designed to occur anywhere in the primary holding material, or could be purposely designed to propagate at precise tear regions. These tear regions may even have optional perforations or have precuts at the edge, for example. Empirical observations have found that the foregoing stretch and tear characteristics are effective for minimizing and virtually eliminating the unwanted turniquette effect.  
         [0064]     It is to be understood that the foregoing detailed description and the embodiments shown in the drawings are illustrative embodiments of the invention. Various alternatives and modifications may be made without departing from the spirit and scope of the invention. Thus, by way of example and not of limitation, in most of the embodiments shown herein, and specifically the embodiments of  FIGS. 1-7  and  11 , the secondary, functional securing may be accomplished using flexible elastic tape  30  as indicated in  FIG. 1 , or straps  110  as suggested in  FIG. 10 . Further, immobilization straps may be employed in all disclosed embodiments, in addition to the tacking arrangements as shown. Regarding the construction of the blanks, they may be of other forms than that shown in  FIG. 2 , and may include multiple layers of high strength material, for example, instead of a spacer material. Also, concerning hook receivable material, it may be in the form of patches of VELCRO® material, UBL material, or napped material, for example. More generally the variations suggested by any of the drawings or related description are applicable to the other embodiments disclosed herein. Instead of being water hardenable, the splints may include two materials with arrangements for combining the materials to initiate hardening. Accordingly, the present specification is not limiting the invention precisely as described in detail hereinabove and shown in the drawings.  
         [0065]     While the specification describes particular embodiments of the present invention, those of ordinary skill can devise variations of the present invention without departing from the inventive concept.