Isolated distal radius fracture
Carpal bone fractures that do not require a thumb spica splint (triquetrum, hamate, pisiform, trapezoid)
Severe wrist sprains
Immobilization for soft tissue injuries of the hand or wrist (eg, cellulitis Cellulitis Cellulitis is acute bacterial infection of the skin and subcutaneous tissue most often caused by streptococci or staphylococci. Symptoms and signs are pain, warmth, rapidly spreading erythema... read more )
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 (enough to cover the area from metacarpophalangeal [MCP] joints to the mid-forearm)
Roll padding (eg, cotton roll) 7.5-cm (3-inch) width
Plaster or fiberglass splinting material, 7.5- to 10-cm (3- to 4-inch) width—wide enough to cover from the MCP joints and extend along the volar surface of the hand and forearm to the mid-forearm
Strong scissors and/or shears
Elastic bandage, usually 7.5- to 10-cm (3- to 4-inch) width
Lukewarm water and bucket or other container
The volar splint does not prevent pronation or supination. If these motions should be immobilized, a sugar tong splint How To Apply a Sugar Tong Arm Splint A sugar tong arm splint is a device applied to immobilize the wrist and arm to prevent supination and pronation of the wrist and forearm. Distal radius fracture Distal ulna fracture None Thermal... read more should be used.
The patient should be positioned so that the operator has appropriate access to the patient's affected hand.
Splint the wrist at 10 to 20° extension.
Step-by-Step Description of Procedure
Wear nonsterile gloves.
Apply stockinette, covering the area from distal to the MCP joints to the mid-forearm.
Make a hole in the stockinette to allow protrusion of the thumb.
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.
Smooth the padding as necessary. Tear away any areas of excess padding to prevent areas of increased pressure on the skin.
Lay out a length of splint material matching the distance from just proximal to the MCP joints to the mid-forearm volar surface of the forearm—it should be just shorter than the area covered by the padding.
Unroll additional splint material, folding it back and forth along the first length until there are 8 to 10 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 from the MCP joints to the mid-forearm along the volar surface.
Fold the extra stockinette and cotton padding over the 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.
Maintain the wrist at 10 to 20° extension until the splinting material hardens.
Check distal neurovascular status (eg, capillary refill, distal sensation, finger flexion and extension).
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
Do not immobilize the wrist at 0° extension/flexion. Avoid flexion of the wrist.
Tips and Tricks
Warm water makes plaster set more quickly, so if you are unfamiliar with applying splints use cooler water to increase your working time.