Short Arm Splinting Technique

Updated: Dec 21, 2015
  • Author: Dave Nelles, MD; Chief Editor: Erik D Schraga, MD  more...
  • Print
Technique

General Steps in Splinting

Once the steps of preparation are complete, the splint may be applied. Each type of short arm splint is applied somewhat differently, but there are basic steps that are common to all of them.

A stockinette should be placed over any part of the arm to which the splint will be applied. This stockinette should be cut long on each end so that it extends past the splinted area (see the image below).

Stockinette applied to arm. Stockinette applied to arm.

After the stockinette is placed, several layers of cotton cast padding are applied, with close attention paid to areas of bony prominence, such as the ulnar head and knuckles (see the image below). For simple splints, the layers of padding and splint material may be applied together. Commercial preparations consisting of fiberglass surrounded by padding material are also available.

Cotton cast padding is applied over stockinette, w Cotton cast padding is applied over stockinette, with special care taken to pad any bony prominences well.

In the case of splint application to maintain fracture reduction, a three-point mold technique is used. This involves applying pressure at the fracture site on one side while simultaneously applying pressure above (proximally) and below (distally) on the opposite side.

The mold technique is performed while the splint is hardening. Fingertraps should be used during the mold to avoid focal points of pressure on the skin. Fractures that have been reduced have a tendency to fall back into their original angulation, and application of a splint in this manner can help maintain the reduction. The pressure at these locations should be maintained until the splinting material is fully hardened.

Next:

Ulnar Gutter Splint

The ulnar gutter splint is applied to the ulnar aspect of the arm. Its proximal extent depends somewhat on the location of injury but should extend at least above (proximal to) the ulnar midshaft. Distally, the splint extends over the metacarpophalangeal joints at least to the proximal interphalangeal joints and possibly past the distal interphalangeal joints, depending on the location of injury.

This splint covers the fourth and fifth digits both volarly and dorsally. For injuries to the fourth digit or metacarpal, the third digit should be included as well. Again, the arm should be placed in its position of function prior to splinting. Cast padding should be placed between the involved digits to avoid skin maceration. [1] (See the image below.)

Ulnar gutter splint with plaster applied over cast Ulnar gutter splint with plaster applied over cast padding and with elastic wrap applied over plaster.
Previous
Next:

Radial Gutter Splint

The radial gutter splint is similar in function to the ulnar gutter splint, except that it is used for injuries to the second or third rays. It is applied in much the same fashion as the ulnar gutter splint, but on the radial aspect of the arm. The thumb is left free, and the second and third digits are splinted as with an ulnar gutter splint. (See the image below.)

Radial gutter splint. Radial gutter splint.
Previous
Next:

Thumb Spica Splint

The thumb spica splint is applied to the radial aspect of the distal forearm. It extends proximally to the radial midshaft or higher. Distally, it encircles the thumb and extends to the interphalangeal joint of the thumb or past it, as necessary (see the image below). The thumb may be slightly flexed at the joints. [12, 13]

Thumb spica splint made with prefabricated fibergl Thumb spica splint made with prefabricated fiberglass splinting material.
Previous
Next:

Volar/Dorsal Slab Splint

Volar and dorsal slab splints are applied to the volar (anterior) and dorsal (posterior) aspects of the arm, respectively (see the images below). Their proximal and distal extent depends on the location of injury. A typical use for a volar splint after carpal tunnel surgery would have the splint extend proximally to the midarm and distally to the midpalm.

Volar (left) and dorsal (right) slab splints made Volar (left) and dorsal (right) slab splints made with prefabricated fiberglass splinting material.
Dorsal slab splint with elastic wrap. Dorsal slab splint with elastic wrap.
Previous
Next:

Sugar-Tong Splint

The sugar-tong splint is a long slab of either plaster or fiberglass folded into the shape of a U (see the image below). The splint goes down the dorsal aspect of the arm, loops around the distal humerus region with the elbow bent at approximately 90º, and goes back up the volar aspect of the arm. This splint is designed to limit pronation and supination.

Sugar-tong splint. Sugar-tong splint.
Previous