eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures
Splinting, Volar
Updated: May 15, 2009
Introduction
In general, splints are applied to decrease movement and provide support and comfort through stabilization of an injury. Splints are primarily used to stabilize nonemergent injuries to bones until the patient can be evaluated by a consultant such as an orthopedic surgeon. Splints are also used to assist in primary healing or to temporarily immobilize an extremity prior to surgery (eg, open fracture).1 Unlike casts, splints are noncircumferential and often preferred in the emergency department (ED) setting, since injuries are often acute and continued swelling can occur. All patients with injuries that are splinted should be referred for evaluation by a consultant in a timely fashion (usually within 2-7 days, depending on the reason for splinting).
Volar splint. Image courtesy of Kenneth R. Chuang, MD.
Indications
A volar splint can be used for various injuries, including the following:
- Soft tissue injuries of the wrist and hand
- Fractures of the second, third, and fourth metacarpals
- Fractures of the second, third, and fourth phalanges
- Positioning for rheumatoid arthritis
- Certain wrist fractures, including a pisiform fracture
- Positioning in the treatment of carpal tunnel syndrome (median nerve compressive neuropathy)
Contraindications
- Absolute contraindications: None
- Relative contraindications in injuries that require immediate evaluation or intervention by a consultant (eg, orthopedic surgeon, hand surgeon, plastic surgeon)
- Complicated fractures
- Open fractures
- Injuries with associated neurovascular compromise
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References
Howes DS, Kaufman JJ. Plaster splints: techniques and indications. Am Fam Physician. Sep 1984;30(3):215-21. [Medline].
Sacchetti A, Senula G, Strickland J, Dubin R. Procedural sedation in the community emergency department: initial results of the ProSCED registry. Acad Emerg Med. Jan 2007;14(1):41-6. [Medline].
Kaplan SS. Burns following application of plaster splint dressings. Report of two cases. J Bone Joint Surg Am. Apr 1981;63(4):670-2. [Medline].
Hutchinson MJ, Hutchinson MR. Factors contributing to the temperature beneath plaster or fiberglass cast material. J Orthop Surg Res. Feb 25 2008;3:10. [Medline].
Halanski MA, Halanski AD, Oza A, Vanderby R, Munoz A, Noonan KJ. Thermal injury with contemporary cast-application techniques and methods to circumvent morbidity. J Bone Joint Surg Am. Nov 2007;89(11):2369-77. [Medline].
Chudnofsky C, Byers S. Splinting techniques. In: Roberts J, Hedges J. Clinical Procedures in Emergency Medicine. 4th. Philadelphia: WB Saunders Company; 2004:989.
Menkes J. Initial evaluation and management of orthopedic injuries. In: Tintinalli J, Kelen G, Stapczynski J. Emergency Medicine: A Comprehensive Study Guide. 6th. New York: McGraw-Hill Professional; 2003:1651.
Further Reading
MedlinePlus: Hand Injuries and Disorder
JAMA Patient Page: Detecting carpal tunnel syndromeKeywords
volar splint, wrist fracture, carpal tunnel syndrome, pisiform fracture, splinting, volar splinting, volar, splint, metacarpal, phalanges, ace wrap, ace bandage, plaster, thermal burn, pressure sore, finger swelling, thermal injury
