Thumb metacarpal fracture
Thumb ulnar collateral ligament injuries
De Quervain's tenosynovitis
Thermal injury (caused by the exothermic reaction between plaster or fiberglass and water)
Excessive pressure causing skin sores and/or ischemic injury
Excessive tightness of circumferential wrapping may contribute to compartment syndrome Compartment Syndrome Compartment syndrome is increased tissue pressure within a closed fascial space, resulting in tissue ischemia. The earliest symptom is pain out of proportion to the severity of injury. Diagnosis... read more
Stockinette (one piece to cover the area from MCP joints to mid-forearm and a second piece to cover the thumb from the tip to the base of the metacarpal)
Roll padding (eg, cotton roll) 5-cm (2-inch) width
Plaster or fiberglass splinting material 7.5-cm (3-inch) width—enough to cover from the DIP joint of the thumb to the mid-forearm
Strong scissors and/or shears
Elastic bandage 5 cm (2-inch) width
Lukewarm water and bucket or other container
The patient should be positioned so that the operator has appropriate access to the patient's affected hand.
Maintain the thumb in a slightly flexed and abducted position as if holding a narrow cup or the stem of a wine glass.
Extend the wrist at 10 to 20°.
Unless there is additional injury, the splint should allow unrestricted motion of the 2nd through 4th MCP joints.
Step-by-Step Description of Procedure
Wear nonsterile gloves.
Apply stockinette to cover the thumb.
Cut a hole in the second stockinette to allow for protrusion of the thumb.
Apply second stockinette to cover the area from the MCP joints to the mid-forearm
Wrap the padding from the MCP joint to the mid-forearm slightly beyond the area to be covered by the splint material; overlap each turn by half the width of the padding and periodically tear the wrapping across its width to decrease the risk of tissue compression
Wrap the padding around the thumb.
Smooth the padding as necessary. Ensure there are no folds in the padding. Tear away any excess padding to prevent areas of localized pressure on the skin.
Lay out a length of splint material matching the distance from just past the DIP joint of the thumb to the mid-forearm.
Unroll additional splint material, folding it back and forth along the first length until there are 6 to 8 layers (when using single-layer rolls).
Alternatively, if using ready-made splint material, cut a single piece to the above length.
Immerse the splinting material in lukewarm water.
Squeeze excess water from the splinting material (do not wring out plaster).
Apply the splint material around the thumb and radial side of the forearm.
Fold the extra stockinette and cotton padding to cover all edges of the splinting material.
Wrap the elastic wrap over the splinting material distally to proximally and overlap each revolution by half the width of the elastic wrap.
Smooth out the splinting material using your palms rather than your fingertips to conform to the contour of the arm to fill in the interstices in the material.
Check the distal neurovascular status (eg, capillary refill, distal sensation, finger flexion and extension).
Thumb spica splint
Advise the patient to keep the splint dry.
Arrange or recommend appropriate follow-up.
Instruct the patient to watch for complications such as worsening pain, paresthesias/numbness, and color change to the fingers.
Instruct the patient to seek further care if pain cannot be controlled with oral drugs at home.
Warnings and Common Errors
Ensure padding and elastic wraps are not applied too tightly.
The base of the thumb is a common site for excess plaster folds in this splint.
Additional padding may be needed over the radial styloid.
Tips and Tricks
Cutting the splinting material lengthwise along the length of the thumb portion of material (from tip to the MCP joint) can allow for better molding around the thumb.
Alternatively, small notches can be cut at the base of the thumb perpendicular to the length of the splint to prevent bunching of the plaster in this area.
Warm water makes plaster set more quickly, so if you are unfamiliar with applying splints use cooler water to increase your working time.
For larger patients, 3-inch cotton padding may be used for the forearm portion of the wrap.