Background
In general, splints are applied to decrease movement and provide support and comfort through stabilization of an injury. They are primarily used to stabilize nonemergency injuries to bones until the patient can be evaluated by a consultant (eg, an orthopedic surgeon). Splints are also used to assist in primary healing or to temporarily immobilize an extremity before surgery (eg, for open fracture). [1]
Unlike casts, splints are noncircumferential. They are often preferred in the emergency department (ED) setting, where injuries are frequently 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). [2, 3]
Indications
A volar splint can be used for various injuries, [4] including the following:
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Soft-tissue injuries of the wrist and hand [5]
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Fractures of the second, third, and fourth metacarpals
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Fractures of the second, third, and fourth phalanges
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Positioning for rheumatoid arthritis
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Certain wrist fractures, including a pisiform fracture
Contraindications
There are no absolute contraindications for volar splinting. Relative contraindications in injuries that require immediate evaluation or intervention by a consultant (eg, an orthopedic surgeon, hand surgeon, or plastic surgeon) include the following:
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Complicated fractures
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Open fractures
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Injuries with associated neurovascular compromise
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Equipment for volar splinting. Image courtesy of Kenneth R Chuang, MD.
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Appropriate coverage of patient for volar splinting. Video courtesy of Kenneth R Chuang, MD.
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Removal of jewelry and rings to avoid ischemia from swelling. Video courtesy of Kenneth R Chuang, MD.
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Application of cotton padding for volar splint. Video courtesy of Kenneth R Chuang, MD.
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Application of stockinette for volar splint. Video courtesy of Kenneth R Chuang, MD.
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Measurement of dry plaster for volar splint. Video courtesy of Kenneth R Chuang, MD.
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Wetting of plaster for volar splint. Video courtesy of Kenneth R Chuang, MD.
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Application of wet plaster for volar splint. Video courtesy of Kenneth R Chuang, MD.
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Application of bandage wrap for volar splint. Video courtesy of Kenneth R Chuang, MD.
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Molding of volar splint. Video courtesy of Kenneth R Chuang, MD.
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Test neurovascular function and capillary refill. Video courtesy of Kenneth R Chuang, MD.
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Volar splint. Image courtesy of Kenneth R Chuang, MD.
