Patient Education and Consent
Patients should be instructed on proper splint care. The splint should be kept clean and dry. Plaster will break down if submerged in water, and once this occurs, the splint will no longer provide stability. Fiberglass will not weaken, but the cotton padding inside will become wet and remain so against the skin. This can contribute to skin breakdown.
On occasion, a splint may be applied in a manner that leads to undue pressure or abrasion at certain areas of the skin. Patients should be instructed not to modify the splint on their own but to return to their healthcare provider promptly so that the splint can either be modified or changed.
Most important, patients should be instructed on the symptoms of possible compartment syndrome. Pain that seems to be out of proportion to the injury or that increases after splinting is the primary early symptom of impending compartment syndrome. Changes in neurovascular status (eg, dusky or pale fingertips, numbness, or tingling) are late signs of compartment syndrome. By the time these symptoms manifest, permanent damage may already have occurred .
Equipment
Certain supplies are needed to apply a short arm splint of any kind. Cast padding, splinting materials (plaster or fiberglass), and water are all that is truly needed to apply a proper splint. For some fractures, especially distal radius fractures (DRFs), the use of finger traps and weights hung from the arm may facilitate fracture reduction and splint application through ligamentotaxis (see the image below).
Short arm splinting. Use of finger traps and weights in fracture reduction and splinting.
The material used to construct the splint can be either plaster or fiberglass. Plaster is cheaper and generally considered easier to apply because of its superior flexibility in comparison with fiberglass. [16] Both materials generate heat during the process of setting and carry a risk of thermal burn during application.
Fiberglass is more radiolucent and lighter than plaster, and these qualities make it desirable to both the patient and physician. However, the increased cost and difficulty of application may offset these benefits. For most situations in the upper extremity (usually temporary fixation), a well-padded plaster splint is sufficient.
Patient Preparation
Anesthesia
The type of anesthesia required for splint application depends on the injury and patient’s condition. In most acute injuries to the forearm and hand, a splint can be applied with only local or regional anesthesia. On rare occasions, moderate sedation may be required for proper application of the splint without undue patient discomfort.
Positioning
The patient may be either supine or in a seated position. The arm should be carefully placed in the position of function, with the wrist slightly extended, the metacarpophalangeal (MCP) joints flexed toward 90º, and the arm in neutral supination (see the image below).
Short arm splinting. Position of function for arm. Elbow is flexed near 90 degrees but not past. Arm is in neutral rotation. Wrist is slightly extended, with metacarpophalangeal joints flexed.
The wrist should be splinted in neutral position, rather than the extension present in many prefabricated splints. [17]
Monitoring & Follow-up
Once the splint is applied and fully hardened, an elastic wrap is often used to hold the splint and to protect it. It is, once again, important to observe and document the neurovascular status of the involved arm. Any changes in the neurovascular status as compared with the presplinting examination should be considered the result of splint application (or fracture reduction). Efforts should be made to reverse that change, including removal of the splint.
The patient should be asked about his or her comfort level in the splint. Any discomfort felt immediately after splinting could indicate improper splint application and increase the risk of complications. Timely follow-up is encouraged to avoid excessive time in the splint and to receive prompt care for the injury. For the majority of conditions, follow-up should be done within 2 weeks of splinting.
-
Short arm splinting. Use of finger traps and weights in fracture reduction and splinting.
-
Short arm splinting. Position of function for arm. Elbow is flexed near 90 degrees but not past. Arm is in neutral rotation. Wrist is slightly extended, with metacarpophalangeal joints flexed.
-
Short arm splinting. Stockinette applied to arm.
-
Short arm splinting. Cotton cast padding is applied over stockinette, with special care taken to pad any bony prominences well.
-
Short arm splinting. Ulnar gutter splint with plaster applied over cast padding and with elastic wrap applied over plaster.
-
Short arm splinting. Radial gutter splint.
-
Short arm splinting. Thumb spica splint made with prefabricated fiberglass splinting material.
-
Short arm splinting. Volar (left) and dorsal (right) slab splints made with prefabricated fiberglass splinting material.
-
Short arm splinting. Dorsal slab splint with elastic wrap.
-
Short arm splinting. Sugar-tong splint.
