Arm, Wrist, and Hand Splints and Casts
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Introduction
Splints
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Casting
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Taping
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Splinting
- volar splint
- ulnar gutter splint
- dorsal splint
Volar Splint
Position of safety: Wrist in extension, MCPs in 70-90% flexion, fingers fully extended.
Place padding between fingers to prevent sin sogginess
Ulnar Gutter Splint
Useful for boxer's fracture (# of 5th +/- 4th metacarpal neck.
Reduce and stabilize
Dorsal Splint
Useful for flexor tendon lacteration to keep tension off.
Short-Arm Casts
Short-arm casts are generally used for stable wrist sprains, as well as stable fractures of the distal radius, carpal bones, and metacarpals. In general, padding is 3 inches wide, and plaster is 4 inches for adults and 3 inches for children or adolescents.
The patient should be seated or supine, with arm abducted to 90 degrees and elbow flexed to 90 degrees. The wrist should be in slight extension and in the position of function. Chinese finger traps can be used to support the arm.
The cast should extend from one inch below the elbow flexion crease to the palm, stopping just short of the distal palmar crease to allow for full MCP motion. The thumb is also able to move.
Pronation and supination can occur, along with some wrist movement.
If the wrist or thumb need to be immobilized, a short-arm thumb spica may be used. This is used if there is injury to the scaphoid, trapezium, or first metacarpal.
Patient Education
Immobilize the injury for 48-72 hours to prevent swelling. Ice, in an inclosed container, may be used to reduce inflammation.
Keep splint or cast dry. If it does become wet, use a hair dryper on cool.
Do not insert anything under the cast, as injury can cause occult infection.
If the patient notices worsening pain, tightness, numbness, toe discoloration, or fever, they should be immediately assessed.
Cast Removal
Use repeated plunging cuts instead of dragging the saw to prevent burns. Widen the cuts with a car spreader, and cut padding and stockinette with blunt-tipped scissors.
Complications
Informed consent is important prior to immobilization. Decreased strength and flexibility, occasionally permament, are common.
Compartment syndrome can occur if casting is done before swelling is maximized. If worsening pain occurs, the cast should be immediately bivalved.
Cast loosening can occur as swelling subsides, leading to inadequate stability and immobilization.
Skin necrosis can occur above bony prominences. This can be avoided by using extra padding, or by placing a window to avoid ongoing irritation.
Joint stiffness is frequent. It can be avoided by using the minimum time required for healing.
Resources and References
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