Equipment
Equipment used in volar splinting includes the following:
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Stockinette
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Padding (eg, Webril)
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Plaster - For injuries or reductions that require shorter drying times, faster-setting plaster is available (eg, Specialist Extra Fast Setting Plaster); however, as plaster dries faster, the risk of thermal injury increases; for most splints, regular plaster (eg, Specialist Fast Setting Plaster) is appropriate
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Bandage or wrap (eg, Bias bandage or ACE bandage)
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Clean room-temperature water in a basin
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Trauma shears or a pair of medical scissors without pointed ends
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Chux pads and bed sheet
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Tape or bandage clips
Alternatively, prefabricated fiberglass (eg, Orthoglass) can be used in place of the stockinette, plaster, and padding. (See the image below.)
Meals et al tested seven different volar wrist splint designs (70 splints, including 10 of each design) in an effort to determine whether splint material (plaster or fiberglass), thickness (eight-, 10-, or 12-ply), or longitudinal ridging (with or without) affected the strength of the splint. [11] They found that for the plaster splints, more layers of material and the addition of longitudinal ridging increased splint strength. Ridged eight-ply plaster splints were stronger than nonridged 10-ply plaster splints. Fiberglass splints were comparable to ridged eight-ply plaster splints in strength and thus might be a lighter, similarly effective, and cheaper alternative.
Patient Preparation
Anesthesia
Splinting is usually tolerated without the use of anesthesia. However, if significant manipulation or reduction of the injury is required during the splinting process, anesthetic techniques may be used. Acceptable techniques include the following:
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Administration of a hematoma block or nerve block
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Procedural sedation with appropriate monitoring [12]
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Administration of oral or intravenous (IV) pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid analgesic agents
With the administration of any analgesic agent or the initiation of a formal sedation protocol, care must be taken to avoid oversedation. A complete neurovascular examination should be performed after the splint has been applied.
Positioning
Place the patient in a comfortable position (eg, seated or reclined). Cover the patient with a sheet to avoid splatter from the wet plaster (see the first video below.) Completely expose the injured limb. Remove all jewelry (see the second video below). In particular, rings can cause constriction and ischemia of the fingers with delayed swelling of the soft tissues. If unable to remove a ring, try using soap as a lubricant, or consider a ring cutter.
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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.
