Splinting and Casting Techniques

Figure 6.1

Sugar tong splint after padding (left) and application of splint (middle, right)

Volar Splint

A single slab of splint material is placed on the volar aspect of the forearm (Fig. 6.2).

1.

Indications: For stable fractures of the distal radius and mild carpal injuries. May be used for immobilization of infections or soft tissue injuries as well.
2.

How to: Wrap the arm with cast padding from the metacarpal heads to the proximal forearm. Place a sheet of plaster or fiberglass over the volar palm to the mid-forearm. If the fingers are to be immobilized, both the padding and the plaster should extend beyond the fingertips. Overwrap with an elastic wrap.

Figure 6.2

Volar splint

Posterior/Ulnar Long-Arm Splint

A slab of splint material is placed along the posterior aspect of the arm from the level of the axilla to the metacarpophalangeal joints, with the elbow flexed to 90° (Fig. 6.3).

1.

Indications: Stable fractures or dislocations of the elbow. It can also be used as part of a coaptation splint or in conjunction with a sugar tong splint, when more stability is required.
2.

How to: Wrap the arm with cast padding from the metacarpal heads to the proximal arm. Take care to use additional padding at the medial and lateral epicondyle and the olecranon. Place a long slab of plaster or fiberglass from the posterior proximal arm, along the posterior elbow, and around the ulnar forearm. Overwrap with an elastic bandage.

Figure 6.3

Posterior/ulnar long-arm splint padding (above) and after application of splint (below)

Thumb Spica Splint

A radially based splint that begins on the forearm, crosses the wrist, and wraps around the thumb (Fig. 6.4).

1.

Indications: Fractures or suspected fractures of the scaphoid, fractures of first metacarpal or the phalanges of the thumb.
2.

How to: Wrap from the distal palm to the proximal forearm with cast padding. Additional cast padding should be wrapped around the thumb, making sure adequate padding is present over all sites. A slab of plaster or fiberglass should then be placed over the radial wrist, extending as far as needed onto the thumb, and gently wrapped around the radial and ulnar aspect of the thumb to immobilize it.

Figure 6.4

Thumb spica splint

Intrinsic Plus Splint

A splint that has volar and dorsal components. Intrinsic plus describes a position of 20–30° of wrist extension, 70–80° MCP flexion, and full PIP/DIP extension (Fig. 6.5).

1.

Indications: Fractures of metacarpals.
2.

How to: Wrap the hand, wrist, and distal forearm with cast padding. This splint should always use plaster, as it molds more tightly to the shape of the hand and maintains the required position. Every effort should be made to hold the patient in a position similar to the desired final result throughout the process to prevent bulging or tearing of the cast padding. Place one slab of 6–8 sheets of plaster on the dorsal aspect and one slab of 5–6 sheets on the volar aspect of the hand and wrist, extending to the distal forearm. The desired position must be maintained until the plaster reaches a rigid state.