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How To Apply a Volar Arm Splint

By

Miranda Lewis

, MD, University of Washington

Last full review/revision Jul 2021| Content last modified Jul 2021
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Topic Resources

A volar splint is device applied to immobilize the wrist and hand.

Indications

Contraindications

  • None

Complications

Equipment

  • 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

  • Nonsterile gloves

Additional Considerations

Positioning

  • 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).

Aftercare

  • 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.

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