Volar Splinting Periprocedural Care

Updated: Mar 11, 2016
  • Author: Nicolai B Baecher, MD; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Equipment

Equipment used in volar splinting includes the following:

  • Stockinette
  • Padding (eg, Webril)
  • 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
  • Bandage or wrap (eg, Bias bandage or Ace bandage)
  • Clean room-temperature water in a basin
  • Trauma shears or a pair of medical scissors without pointed ends
  • Chucks pads and bed sheet
  • Tape or bandage clips

Alternatively, prefabricated fiberglass (eg, Orthoglass) can be used in place of the stockinette, plaster, and padding. (See the image below.)

Equipment for volar splinting. Image courtesy of K Equipment for volar splinting. Image courtesy of Kenneth R Chuang, MD.
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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:

  • Administration of a hematoma block or nerve block
  • Procedural sedation with appropriate monitoring [6]
  • Administration of oral or intravenous 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, take care 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.

Appropriate coverage of patient for volar splinting. Video courtesy of Kenneth R Chuang, MD.
Removal of jewelry and rings to avoid ischemia from swelling. Video courtesy of Kenneth R Chuang, MD.
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