Nondisplaced or minimally displaced fractures of the distal radius and ulna

 Maintaining reduced fractures of the distal radius

 Forearm fractures (radius or ulna shaft fractures)

 Stockinette: 2-inch width (1-inch width optional)

 Cast padding/Undercast padding: 3- and 4-inch width

 Plaster or synthetic (prefabricated) splint material: 3- or 4-inch width

 Elastic bandage/Wrap: 2-, 3-, and 4-inch width

1) With the patient’s arm flexed to approximately 90 degrees and their wrist at neutral, fit the 2-inch stockinette in length from just beyond the fingertips up to midway of the humerus. Cut a hole in the stockinette to adequately accommodate the thumb (Fig. 11-1, B).

2) At the antecubital fossa, cut a slit in the stockinette (epicondyle to epicondyle), and pull the proximal portion of the stockinette to overlap the distal portion (or vice versa) (Figs. 11-1, C and 11-1, D).

3) Begin wrapping the padding at the metacarpal heads (MCHs) and proceed proximally with a 50% overlay. Figure-of-eight wrap around the elbow and apply ample padding around the bony prominences of the epicondyles. Continue wrap up to the midhumerus, but keep about 2 fingerbreadths distal to the stockinette edge (Fig. 11-1, E).

4) Measure so that the selected splint material fits as a “U” around the elbow and along the dorsal and volar sides of the arm all the way to the MCHs, respectively (Fig. 11-1, F).

5) Apply the splint material beginning on the volar side at the palmar crease of the hand, proximally toward the elbow, around the elbow, and back to just distal to the MCHs on the dorsal side of the hand. Any excess material can be trimmed away or folded back on itself.

6) Pull the underlying stockinette and padding back over the splint at the distal and proximal ends, respectively (Fig. 11-1, I). This will protect and pad the patient from the edge of the splint at those areas.

7) Wrap the elastic bandage over the wet splint to just secure it in place. Wrap distal toward proximal; use a figure-of-eight wrap to cover around the elbow (Fig. 11-1, J).

8) The splint should be molded to maintain given reduction or with the wrist at neutral (functional) unless otherwise indicated.

 Distal humerus fractures

 Radial head/neck fractures

 Proximal ulna fractures

 Reduced elbow dislocations

 Elbow sprains/strains

 Stockinette: 2-inch width (1-inch width optional)

 Cast padding/Undercast padding: 3- and 4-inch width

 Plaster or fiberglass (prefabricated) splint material: 4- or 5-inch width

 Elastic bandage/Wrap: 2-, 3-, and 4-inch width

1) With the patient’s arm flexed to approximately 90 degrees and their wrist at neutral, fit the 2-inch stockinette in length from just beyond the fingertips up to (and with some gather at) the axilla. Cut a hole in the stockinette to adequately accommodate the thumb (Fig. 11-2, B).

2) At the antecubital fossa, cut a slit in the stockinette (epicondyle to epicondyle) and pull the proximal portion of the stockinette to overlap the distal portion (or vice versa) (Fig. 11-2, C).

3) Begin wrapping the padding at the MCHs and proceed proximally with a 50% overlay. Figure-of-eight wrap at the elbow, and apply ample padding around the bony prominences of the epicondyles. Continue wrapping up to the axilla (Fig. 11-2, D).

4) Measure so that the selected splint material fits from the fifth MCH to the axilla.

5) Apply the splint material beginning on the ulnar side at the palmar crease along the fifth metacarpal of the hand, along the ulna, posteriorly along the elbow up just distal to the axilla. Any excess material can be trimmed away or folded back on itself (Fig. 11-2, E).

6) Pull the underlying stockinette and padding back over the splint at the distal and proximal ends, respectively. This will protect and pad the patient from the edge of the splint at those areas.

7) Wrap the elastic bandage over the wet splint to just secure it in place. Wrap distal toward proximal; use a figure-of-eight wrap to cover around the elbow.

8) The splint should be molded to maintain given reduction and with the wrist in a functional position unless otherwise indicated.

 Finger injuries

 Metacarpal injuries

 Carpal injuries (excluding occult scaphoid or trapezium fractures)

 Protection of lacerations of the hand/wrist/forearm

 Wrist sprains/strains

 Stockinette: 2-inch width (1-inch width optional)

 Cast padding/Undercast padding: 3-inch width

 Plaster or synthetic (prefabricated) splint material: 3- or 4-inch width

 Elastic bandage/Wrap: 2-inch and 3-inch width

1) With the patient’s wrist at neutral, fit the 2-inch stockinette in length from just beyond the fingertips up to the antecubital fossa. Cut a hole in the stockinette to adequately accommodate the thumb (Fig. 11-3, B).

2) Begin wrapping the padding at the MCHs and proceed proximally with a 50% overlay. Continue wrapping up to the antecubital fossa (Figs. 11-3, D and 11-3, E).

3) Measure so that the selected splint material fits in length from the MCHs to within about two to three fingerbreadths (about 2 inches) of the antecubital fossa.

4) Apply the splint material beginning on the volar side at the palmar crease of the hand, proximally toward the antecubital fossa. Any excess material can be trimmed away or folded back on itself (Fig. 11-3, F).

5) Pull the underlying stockinette and padding back over the splint at the distal and proximal ends, respectively. This will protect and pad the patient from the edge of the splint at those areas (Fig. 11-3,G).

6) Wrap the elastic bandage over the wet splint to secure it in place. Wrap distal toward proximal.

7) The splint should be molded as to counter the given injury or with the wrist at neutral unless otherwise indicated.

 Thumb injuries

 Wrist injuries (occult/suspected scaphoid or trapezium fractures)

 Wrist sprains/Strains

 Stockinette: 2-inch width (1-inch width optional but shown)

 Cast padding/Undercast padding: 3-inch width

 Plaster or synthetic (prefabricated) splint material: 3- or 4-inch width

 Elastic bandage/Wrap: 2- and 3-inch width

1) With the patient’s wrist at neutral, fit the 2-inch stockinette in length from just beyond the fingertips up to the antecubital fossa. Cut a hole in the stockinette to adequately accommodate the thumb (Fig. 11-4, B).

2) Begin wrapping the padding at the MCHs and proceed proximally with a 50% overlay. Continue wrapping up to just distal to the antecubital fossa (Figs. 11-4, D and 11-4, E).

3) Measure so that the selected splint material fits in length from the MCHs to within about two to three fingerbreadths (about 2 inches) of the antecubital fossa.

4) Apply the splint material centered over the radial border of the thumb and forearm, beginning just proximal to the padded edge of stockinette (or cast/undercast padding) protecting the thumb proximally toward the antecubital fossa. Any excess material can be trimmed away or folded back on itself (Fig. 11-4, F).

5) Pull the underlying stockinette back just over the padding at the distal and proximal ends, respectively. This will protect and pad the patient from the edge of the cast at those areas (Fig. 11-4, G).

6) Wrap the elastic bandage over the wet splint to secure it in place. Wrap distal toward proximal.

 Ring and small finger injuries

 Ring and small finger metacarpal injuries

 Stockinette: 2-inch width (1-inch width optional)

 Cast/Undercast padding: 3-inch width

 Plaster or synthetic (prefabricated) splint material: 4- or 5-inch width

 Elastic bandage/Wrap: 2- and 3-inch width

1) With the patient’s wrist at neutral, fit the 2-inch stockinette in length from about 1 inch beyond the fingertips up to the antecubital fossa. Cut a hole in the stockinette to adequately accommodate the thumb (Fig. 11-5, B).

2) At the distal end of the stockinette, cut a slit in the stockinette longitudinally toward the web space between the long and ring fingers (Fig. 11-5, D).

3) Trim or fold a few layers of cast/undercast padding to place between the length of the ring and small fingers to prevent skin maceration (Fig. 11-5, E).

4) Begin wrapping the padding just at the tips of the ring and small fingers and proceed proximally with a 50% overlay. Continue wrapping up to just distal to the antecubital fossa (Figs. 11-5, F and 11-5, G).

5) Measure so that the selected splint material fits from the tip of the ring finger to the antecubital fossa.

6) Apply the splint material beginning on the ulnar side of the small finger (distally equal to the ring ginger) forming a “gutter” along the fifth metacarpal and the ulna proceeding toward the antecubital fossa. Any excess material can be trimmed away or folded back on itself (Fig 11-5, H).

7) Pull the underlying stockinette and padding back over the splint at the distal and proximal ends, respectively. This will protect and pad the patient from the edge of the splint at those areas.

8) Wrap the elastic bandage over the wet splint to just secure it in place. Wrap distal toward proximal.

9) The splint should be molded at the fingers, hand, and wrist to maintain a given reduction or counter the given injury as indicated.

 Ankle sprains/Strains

 Medial and lateral malleolus injuries

 Stockinette: 3-inch width

 Cast/Undercast padding: 4- and/or 6-inch width

 Plaster or synthetic (prefabricated) splint material: 3-inch width

 Elastic bandage/Wrap: 4- and 6-inch width

1) With the patient’s ankle at neutral (ankle dorsiflexed to approximately 90 degrees), fit the 3-inch stockinette in length distally from the MTHs up to the patella and popliteal fossa.

2) At the ankle joint, cut a slit in the stockinette (malleolus to malleolus) and pull the proximal portion of the stockinette to overlap the distal portion (or vice versa) (Fig. 11-6, B).

3) Begin wrapping the padding just proximal to the MTHs and proceed proximally with a 50% overlay. Figure-of-eight wrap at the ankle/heel and apply ample padding around the bony prominences of the malleoli. Continue wrapping up to the tibial tuberosity (Fig. 11-6, C).

4) Measure so that the selected splint material fits as a “U” under the heel of the foot and up the ankle along the lateral and medial sides of the leg all the way to even with the level of the fibular head (Fig. 11-6, D).

5) Apply the splint material in the same manner used to measure above. Any excess material can be trimmed away or folded back on itself.

6) Pull the underlying stockinette and padding back over the splint at the distal and proximal ends, respectively. This will protect and pad the patient from the edge of the splint at those areas.

7) Wrap the elastic bandage over the wet splint to just secure it in place. Wrap distal toward proximal; use a figure-of-eight wrap to cover around the ankle and heel.

8) The splint should be molded with the ankle at neutral unless otherwise indicated.